Elsevier

Mayo Clinic Proceedings

Volume 86, Issue 10, October 2011, Pages 960-967
Mayo Clinic Proceedings

ORIGINAL ARTICLE
Ethnic Differences in Cardiovascular Risks and Mortality in Atherothrombotic Disease: Insights From the REduction of Atherothrombosis for Continued Health (REACH) Registry

https://doi.org/10.4065/mcp.2011.0010Get rights and content

Abstract

OBJECTIVE

To determine whether ethnic-specific differences in the prevalence of cardiovascular risk factors and outcomes exist worldwide among individuals with stable arterial disease.

PATIENTS AND METHODS

From December 1, 2003, to June 30, 2004, the prospective, observational REduction of Atherothrombosis for Continued Health (REACH) Registry enrolled 49,602 outpatients with coronary artery disease, cerebrovascular disease, and/or peripheral arterial disease from 7 predefined ethnic/racial groups: white, Hispanic, East Asian, South Asian, Other Asian, black, and Other (comprising any race distinct from those specified). The baseline demographic and risk factor profiles, medication use, and 2-year cardiovascular outcomes were assessed among these groups.

RESULTS

The prevalence of traditional atherothrombotic risk factors varied significantly among the ethnic/racial groups. The use of medical therapies to reduce risk was comparable among all groups. At 2-year follow-up, the rate of cardiovascular death was significantly higher in blacks (6.1%) compared with all other ethnic/racial groups (3.9%; P=.01). Cardiovascular death rates were significantly lower in all 3 Asian ethnic/racial groups (overall, 2.1%) compared with the other groups (4.5%; P<.001).

CONCLUSION

The REACH Registry, a large international study of individuals with atherothrombotic disease, documents the important ethnic-specific differences in cardiovascular risk factors and variations in cardiovascular mortality that currently exist worldwide.

Section snippets

PATIENTS AND METHODS

A detailed description of the study design, methodology, and baseline characteristics of individuals enrolled in the international, prospective REACH Registry has been previously reported.1, 8 Briefly, the registry included outpatients aged 45 years or older with either established atherothrombotic disease (CAD, PAD, or CVD) or 3 or more cardiovascular risk factors from 5587 practices in 44 countries. Study participants were enrolled from December 1, 2003, to June 30, 2004 (except in Japan,

RESULTS

Overall, 49,602 outpatients in the REACH Registry with established atherothrombotic disease at baseline were included in this analysis. At 2 years, 45,191 individuals (91%) were available for follow-up. A total of 747 participants (1.5%) died within the first 2 years, and 3664 (7%) were lost to follow-up at 2 years. The rate of lost to follow-up varied among the ethnic/racial groups: from 3% in East Asians to 16% in blacks. Baseline demographics, including atherosclerotic disease, risk factors,

DISCUSSION

The results of this wide-reaching, contemporary analysis composed of a markedly diverse population with stable CAD, CVD, and/or PAD demonstrate important ethnic-specific variations in the risks, management, and outcomes associated with atherothrombotic disease. Blacks with atherothrombotic disease, mainly comprising African Americans from the United States (95%), had the highest rate of cardiovascular death among the ethnic/racial groups worldwide. In contrast, Asians had significantly lower

CONCLUSION

Our findings from this large global registry of individuals with atherothrombotic disease illustrate several important ethnic differences in treatment patterns and outcomes from the current era. In general, blacks (consisting mainly of African Americans) had higher rates of adverse cardiovascular outcomes, with the highest rate of cardiovascular death among the groups. However, Asians had significantly lower rates of all-cause and cardiovascular death. The underlying etiologies for these

REFERENCES (20)

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A complete list of the REACH Registry investigators is published in JAMA. 2006;295(2):180-189.

We thank sanofi-aventis and Bristol-Myers Squibb for their support of the REACH Registry. The REACH Registry is endorsed by the World Heart Federation. The sponsor was able to review the manuscript before submission but did not have the authority to change any aspect of the manuscript.

Individual reprints of this article are not available.

1

Dr Bhatt has received institutional research support from AstraZeneca, Bristol- Myers Squibb, Eisai, Ethicon, Medtronic, sanofi-aventis, and The Medicines Company.

2

Dr Gersh is a member (<3 years) of the advisory boards of Bristol-Myers Squibb, Boston Scientific, Amorcyte Inc, Merck, Cardiovascular Therapeutics, and AstraZeneca.

3

Dr Röther has received honoraria and consulting fees from sanofiaventis, Bristol-Myers Squibb, Lundbeck, and Boehringer Ingelheim.

4

Dr Goto has received honoraria and consulting fees from Astellas, AstraZeneca, Bayer, Bristol-Myers Squibb, Daiichi-Sankyo, Eisai, GlaxoSmithKline, Kowa, Novartis, Otsuka, sanofi-aventis, Schering-Plough, and Takeda, and he has received research grants from Eisai, Ono, sanofi-aventis, AstraZeneca, Kowa, and Pfizer.

5

Dr Wilson has received grant support from sanofi-aventis.

6

Dr Salette is an employee of sanofi-aventis.

7

Dr Steg has received research grants from sanofi-aventis and has been either a speaker or a consultant for Astellas, AstraZeneca, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, Endotis, GlaxoSmithKline, Medtronic, MSD, Nycomed, sanofi-aventis, Servier, and The Medicines Company.

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