A large scale global study on cardiac care has revealed that there is a gap between what is recommended and what is practiced.

The study, published in the Journal of the American Medical Association ( JAMA ), analyzes information collected by the Reduction of Atherothrombosis for Continued Health ( REACH ) Registry, the world’s largest international database of patients with established atherothrombrosis or with a constellation of risk factors.
REACH includes more than 67,800 heart patients, treated by more than 5,400 physicians in 44 countries.

More than 14% of all patients in the REACH registry are current tobacco users; 40% are overweight; 27% are obese and 44% have diabetes – all of which are emerging as major contributors to aggressive cardiovascular disease. It is interesting to note that the study revealed Europeans as well as North Americans are overweight or obese.

Patients were generally undertreated with statins ( 69.4% overall; range: 56.4% for cerebrovascular disease to 76.2% for coronary artery disease ), antiplatelet agents ( 78.6% overall; range: 53.9% for 3 risk factors to 85.6% for coronary artery disease ), and other evidence-based risk reduction therapies.
Current tobacco use in patients with established vascular disease was substantial ( 14.4% ).
Undertreated hypertension ( 50.0% with elevated blood pressure at baseline ), undiagnosed hyperglycemia ( 4.9% ), and impaired fasting glucose ( 36.5% in those not known to be diabetic ) were common.
Among those with symptomatic atherothrombosis, 15.9% had symptomatic polyvascular disease.

The European Society of Cardiology’s ( ESC ) Euroaspire I and II surveys clearly indicated that cardiovascular risk factors are insufficiently managed in people with proven coronary disease in hospitals in Europe.
REACH extends the Euroaspire findings in post-myocardial infarction European patients to include other groups of patients ( patients in primary care, patients with cerebrovascular disease or peripheral arterial disease ) and to other regions of the world ( Asia, Middle East, Latin America ).

“ The REACH study has substantial implications for the prevention of cardiovascular diseases,” said Ian M. Graham, chairman of the ESC Joint European Societies Cardiovascular Prevention Committee. “ The major risk factors for atherothrombotic disease had been known for many years. What is deeply concerning from the REACH Study is that even patients with atherothrombotic disease continue to carry a very heavy burden of hypertension and hypercholesterolemia. The findings validate the ESC’s explicit policy of total cardiovascular risk estimation and management, rather than focusing on single risk factors.”

The ESC is working on Euroaspire III, the third round of a risk factor management audit within Europe.
Euroaspire III will extend into primary care and will study the management of risk factors in whole families in more detail, as well as evaluate the managements of risk factors in stroke subjects.

“ There is huge potential to reduce the global burden of cardiovascular disease by encouraging a culture of physical activity, avoidance of overweight, and avoidance of tobacco, together with increased detection and better management of risk factors,” said Graham.

Source: European Society of Cardiology, 2006


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