Atherothrombotic Disease, Traditional Risk Factors, and 4‐Year Mortality in a Latin American Population: The REACH Registry
Authors: Cantú‐Brito Carlos , Chiquete Erwin , Ruiz‐Sandoval José L. , Gaxiola Efraín , Albuquerque Denilson C. , Corbalán Ramón , Ramos Alma , Bhatt Deepak L. , Steg P. Gabriel ,   for the REACH Latin America Collaborative Group
Published: May 2012

Background:

Atherothrombosis is becoming the leading cause of chronic morbidity in developing countries. This epidemiological transition will represent an unbearable socioeconomic burden in the near future. We investigated factors associated with 4‐year all‐cause mortality in a Latin American population at high risk.

Hypothesis:

Largely modifiable risk factors as well as polyvascular disease are the main predictors of 4‐year all‐cause and cardiovascular mortality in this Latin American cohort.

Methods:

We analyzed 1816 Latin American stable outpatients (62.3% men, mean age 67 years) with symptomatic atherothrombosis (87.1%) or with multiple risk factors only (12.9%), in the Reduction of Atherothrombosis for Continued Health registry.

Results:

Of patients with symptomatic atherothrombosis, 57.3% had coronary artery disease, 32% cerebrovascular disease, and 11.7% peripheral artery disease at baseline (9.1% polyvascular). The main risk factors were hypertension (76%), hypercholesterolemia (60%), and smoking (52.3%) in patients with established atherothrombosis; and hypertension (89.7%), diabetes (80.8%), and hypercholesterolemia (73.9%) in those with risk factors only. Four‐year all‐cause mortality steeply increased with none (6.8%), 1 (9.2%), 2 (15.5%), and 3 (29.2%) symptomatic arterial disease locations. In patients with only 1 location, cardiovascular mortality was significantly higher with peripheral artery disease (11.3%) than with cerebrovascular disease (6%) or coronary artery disease (5.1%). Significant baseline predictors of 4‐year all‐cause mortality were congestive heart failure (hazard ratio [HR]: 3.81), body mass index <20 (HR: 2.32), hypertension (HR: 1.84), polyvascular disease (HR: 1.69), and age ≥65 years (HR: 1.47), whereas statin use (HR: 0.49) and body mass index ≥30 (HR: 0.58) were associated with a reduced risk.

Conclusions:

Hypertension was the main modifiable risk factor for atherothrombosis and all‐cause mortality in this Latin American cohort. Nearly one‐third of the population with 3 symptomatic vascular‐disease locations died at 4‐year follow‐up.

The REACH registry is sponsored by sanofi, Bristol‐Myers Squibb, and the Waksman Foundation (Tokyo, Japan). The REACH registry is endorsed by the World Heart Federation. The REACH registry enforces a no‐ghostwriting policy. This manuscript was written and edited by the authors, who take full responsibility for its content. Dr. Cantú‐Brito and Dr. Chiquete wrote the first draft of this manuscript.

Dr. Cantú‐Brito has received research grants from sanofi, Ferrer Grupo and Bayer, as well as speaker honoraria from sanofi. Dr. Chiquete has received research grants from sanofi and Ferrer Grupo, as well as speaker honoraria from Novartis. Dr. Ruiz‐Sandoval has received research grants from sanofi, Boehringer Ingelheim, and Ferrer Grupo. Dr. Gaxiola has received research grants from sanofi and Eli Lilly, as well as consultancy and speaker honoraria from Sanofi, Eli Lilly, Pfizer, AstraZeneca, and Abbott. Dr. Albuquerque has received research grants from sanofi, AstraZeneca, Servier, Roche, and BMS/Pfizer, as well as consultancy and speaker honoraria from sanofi and AstraZeneca. Dr. Corbalán has no relevant disclosures. Mrs. Ramos is an employee at sanofi, in the Clinical Research Department. Dr. Deepak L. Bhatt discloses the following relationships ‐ Advisory Board: Medscape Cardiology; Board of Directors: Boston VA Research Institute, Society of Chest Pain Centers; Chair: American Heart Association Get With The Guidelines Science Subcommittee; Honoraria: American College of Cardiology (Editor, Clinical Trials, Cardiosource), Duke Clinical Research Institute (clinical trial steering committees), Slack Publications (Chief Medical Editor, Cardiology Today Intervention), WebMD (CME steering committees); Research Grants: Amarin, AstraZeneca, Bristol‐Myers Squibb, Eisai, Ethicon, Medtronic, Sanofi Aventis, The Medicines Company; Unfunded Research: PLx Pharma, Takeda. Dr. Steg has received research grants from Servier; consultancy fees/honoraria from Amgen, Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol‐Myers Squibb, Daiichi Sankyo/Eli Lilly alliance, Eisai, GlaxoSmithKline, Medtronic, Merck Sharpe and Dohme, Pfizer, Roche, sanofi, Servier, and The Medicines Company; and has equity ownership in Aterovax.

The authors have no other funding, financial relationships, or conflicts of interest to disclose.