MUSC Medical Links Charleston Links Archives Medical Educator Speakers Bureau Seminars and Events Research Studies Research Grants Catalyst PDF File Community Happenings Campus News

Return to Main Menu

Blood clots raise risk for patients with atherothrombosis 

An international study in which MUSC participated concluded that outpatients with atherothombosis have a high risk of death or major cardiovascular illness especially if more than one vascular bed is diseased.
 
Results of the study, conducted through the Reduction of Atherothrom-bosis for Continued Health (REACH) Registry, was published March 21 in the Journal of the American Medical Association.  
 
REACH also documented high event rates that accrued almost linearly over time in contrast to the sharp rise followed by a leveling off of event rates that usually is seen in patients discharged from the hospital after acute events. MUSC’s Peter F. Wilson, M.D., was one of five lead investigators of the international study, which involved developing a registry of more than 68,000 patients in 44 countries and covering six regions—Latin America, Asia, the Middle East, Australia, Europe and North America. It involved more than 5,000 physician investigators.
 
REACH is the first international outpatient registry to characterize the real-world burden of atherothrombotic disease worldwide. Atherothombosis results from a clogged artery in the heart, brain and legs.
   
The REACH study found that:
  • Within a year, around one in seven patients will die, experience a heart attack or stroke, or be hospitalized from a complication arising from atherothrom-bosis.
  • Patients with atherothrombosis in the legs (peripheral arterial disease: PAD) have a one in five (21 percent) chance of dying, having a heart attack or stroke or being hospitalized due to cardiovascular reasons within one year.
  • During the same period of time, for patients who have atherothrombosis in more than one area (heart, brain and/or legs) this risk doubles.
  • The risk increases depending on the number of arterial beds affected; with 5 percent event rate for patients with risk factors only; 13 percent for patients with risk factors and one diseased vascular bed, 22 percent for patients with risk factors and two diseased vascular beds, and 26 percent for patients with risk factors and three diseased vascular beds.
REACH demonstrated that up to 1.75 million cardiovascular events could be seen in those patients with multiple arterial disease in the United States alone during the next 12 months.
 
For patients without a history of coronary, cerebrovascular or PAD, but who have at least three risk factors for developing these conditions (such as diabetes, high blood pressure, high cholesterol and smoking), around 5 percent had a major event or were hospitalized within one year.
 
“I find these event rates to be high, given that we are dealing with a stable outpatient population treated with contemporary therapy,” said Gabriel Steg, M.D., professor of cardiology at Hospital Bichat-Claude Bernard, Paris, on behalf of the REACH Registry’s Scientific Council. “The impact of polyvascular disease on the risk of event in REACH shows that it is critical that we stop viewing atherothrombosis as a disease of a specific medical specialty—cardiology, neurology, or vascular disease—instead we must view it as a ‘global’ disease. Doctors’ adherence to evidence-based guidelines for treatment are important to manage the risk for this group of patients” Steg said.

The underlying cause of heart attack, stroke and PAD
Atherothrombosis occurs when a blood clot (thrombus) forms on a ruptured plaque (atheroma) in the wall of a blood vessel. Plaques consist of fatty acids and cholesterol, calcium and other materials.
 
The rupture of plaques and the subsequent development of a clot can cause partial or complete blockage of an artery in various parts of the body. When a vessel in the heart is partially or completely blocked by a clot the result can be a heart attack. In the brain, the same process can cause a stroke. Elsewhere in the body, this process can lead to reduction or blockage of blood flow in the arteries of the legs—PAD—a significant risk factor for heart attack or stroke.
 
Atherothrombosis is the common thread linking heart attack, stroke and peripheral arterial disease.
 
The REACH Registry is sponsored by Sanofi-Aventis, Britsol-Myers Squibb, and the Waksman Foundation (Tokyo, Japan), which assisted with the design and conduct of the study and data collection.
 
For additional information, visit http://www.REACHRegistry.org.
   

Friday, April 13, 2007
Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.