The Reduction of Atherosclerosis for Continued Health registry (REACH) is a contemporary cohort of patients with various stages of atherosclerosis, from asymptomatic patients with risk factors to patients who have had previous ischaemic events. The aim of this 4-year follow-up study was to determine the risk of cardiovascular events in stable outpatients with various initial manifestations of atherothrombosis. To do so, 45 227 patients were enrolled between 2003 and 2004, and followed up until 2008. The main outcome measures were the rates of cardiovascular death, myocardial infarction and stroke.

Over the follow-up period, 5481 patients experienced at least one event: 2315 with cardiovascular death, 1228 with myocardial infarction, 1898 with stroke and 40 who sustained a myocardial infarction and stroke on the same day. Of all patients with atherothrombosis, those with a prior history of ischaemic events at baseline (n=21 890) had the highest rate of subsequent ischaemic events compared with patients with stable coronary, cerebrovascular, or peripheral arterial disease (18.3% vs 12.2%; p<0.001). Patients without established atherothrombosis, but with risk factors only, had the lowest risk (9.1%, p<0.001). Mutivariable modelling found that the presence of diabetes (HR=1.44), an ischaemic event in the previous year (HR=1.71) and polyvascular disease (HR=1.99) were each associated with a significantly higher risk of the primary end point.

Conclusion
Data from the Reduction of Atherosclerosis for Continued Health registry suggest that simple clinical descriptors can assist clinicians in identifying high-risk patients in the outpatient setting. In particular, polyvascular disease, a history of previous ischaemic events (particularly in the past 12 months) and the presence of diabetes are associated with increased risk.

▶ Bhatt DL, Eagle KA, Ohman EM, et al. Comparative determinants of 4-year cardiovascular event rates in stable outpatients at risk of or with atherothrombosis. JAMA Published Online First: 2010 Aug 30. doi: 10.1001/jama.2010.1322.