Simple risk factors signal ischemic risk in atherothrombosis patients

2 September 2010

MedWire News: Easily determined clinical characteristics can assist clinicians in identifying patients with various stages of atherothrombosis who are at high risk for future cardiovascular events, researchers report.

Patients with atherothrombosis are at elevated risk for future ischemic events, but the risk may vary depending on their specific manifestations of atherothrombosis, explain Deepak Bhatt (Harvard Medical School, Boston, Massachusetts, USA) and colleagues.

“Accurate knowledge of the major determinants of subsequent ischemic risk would be extremely useful, both for clinical and investigational purposes,” they add.

Bhatt and team therefore studied 45,227 outpatients with coronary artery disease, cerebrovascular disease, peripheral arterial disease or with multiple risk factors for atherothrombosis.

The patients (mean age 68.4 years, 64.7% men), from 3647 centers in 29 countries, were enrolled in the global Reduction of Atherothrombosis for Continued Health Registry and were followed-up annually for up to 4 years.

The researchers report that during the follow-up period, 5481 patients experienced at least one ischemic event, including 2315 who died of cardiovascular causes, 1228 who had a myocardial infarction, 1898 who suffered stroke, and 40 who experienced a myocardial infarction and stroke on the same day.

Among patients with atherothrombosis, those with a prior history of ischemic events at baseline (n=21,890) had the highest rate of subsequent ischemic events (18.3%), while patients with stable coronary, cerebrovascular, or peripheral artery disease (n=15,264) had a lower risk (12.2%). Patients without established atherothrombosis but with risk factors (n=8073) had the lowest risk for subsequent ischemic events (9.1%).

In addition, diabetes increased the relative risk for future ischemic events by 44% among all patients.

The occurrence of an ischemic event in the year before enrollment was associated with a 71% increased risk for a future event, while polyvascular disease was associated with a 99% increased risk for an ischemic event among patients with established atherothrombosis.

“These findings may help in the identification of high-risk populations who may deserve intensive preventive efforts with novel therapies and also in the planning of future clinical trials,” conclude Bhatt and co-authors in the Journal of the American Medical Association.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

JAMA 2010; Advance online publication