Stroke Patients More Likely To Die From Nonstroke Cardiovascular Event

Armen Hareyan's picture
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New two-year data from the REACH Registry presented at the European Stroke Congress, highlight that among those who die after a stroke the vast majority (73%) will die from nonstroke cardiovascular (CV) events. The overall death rate is 4.45%, with 3.23% of these CV deaths from a nonstroke event.

The two-year data from the REACH Registry demonstrate that the risk of secondary ischemic events (including CV death) is very high in patients with previous stroke and/or TIA.

The REACH Registry has demonstrated that there is a high prevalence of atherothrombosis in more than one vascular bed: one-quarter of patients with coronary artery disease (CAD), two-fifths of patients with cerebrovascular disease (CVD) and three-fifths of patients with peripheral artery disease (PAD) also have atherothrombosis in other arterial locations. REACH Registry data also highlight the undertreatment of patients with CVD in the real-world setting. Improving ischemic risk management in these patients is required to prevent hospitalization and death.

Approximately 28% of patients in the REACH Registry have diagnosed CVD at baseline. About 40% of patients with CVD have polyvascular disease. Of the total CVD population at baseline: 71% suffered a prior stroke; 51% had a prior TIA; and, 20% had both.

Two-year data in the CVD population show high event rates for non-fatal stroke (5.9%). The risk of stroke, MI and CV death at two years was 11.5% for the total CVD population. Patients with a history of CVD are at considerable risk of major adverse cardiac events (MACE) and hospitalizations (>20% at two years).

"CVD patients are at high risk of recurrent stroke and other atherothrombotic events. Moreover the REACH Registry has shown that most of these stable stroke patients are at risk of dying from a non-stroke CV event. Prevalence of risk factors, co-morbidities, utilization of secondary prevention therapies and adherence to guidelines all influence the recurrent event rate. The two-year data show that the risk for further atherothrombotic events remains high in this stable population. TIAs often trivialized as 'mini-strokes' with a good prognosis that could be treated on an outpatient basis have nearly as high risk for future atherothrombotic events as stroke patients. Undertreatment is common worldwide and adherence to guidelines needs to be enforced to prevent deaths from heart disease and stroke," said Dr. Joachim Rother, Professor of Neurology at the Department of Neurology, Minden Hospital at the University of Hannover Medical School in Minden, Germany.

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CVD is heterogeneous with large carotid and intracranial arterial disease accounting for about 20-30% of all ischemic strokes. Other causes include cardioembolism (25%), microangiopathy (20%), and cryptogenic stroke. High blood pressure is a risk factor strongly associated with stroke. CVD is a global health problem and the incidence of stroke is increasing worldwide.

This underscores the very high risk factor profile and high percentage of CVD patients with additional atherothrombotic disease manifestations in the REACH Registry which was first published last month in Cerebrovascular Diseases.

"The REACH Registry continues to demonstrate the real-world burden of atherothrombotic disease worldwide. In the case of CVD, further analysis has re-emphasized the need for doctors to adhere to evidence-based guidelines for treatment such as long-term antiplatelet therapy or antihypertensive treatment," said Dr. Gabriel Steg, Professor of Cardiology at Hopital Bichat-Claude Bernard, Paris, on behalf of the REACH Registry's Scientific Council.

In addition to this analysis, REACH investigators presented a poster during the European Stroke Conference 2008 on the risk of coronary events in patients with stroke or TIA. (Risk of coronary events in patients with stroke or TIA: Two-year follow-up data from the REduction of Atherothrombosis for Continued Health (REACH) Registry: Touze E, Rother J, Alberts MJ, Goto S, Hill MD, Aichner F, Steg PG, Bhatt DL, Mas JL, on behalf of the REACH Registry Investigators). Whereas the incidence rates of MI and nonstroke vascular death are only about 1% per year, the risk rises in patients with additional CAD to 2 to 2.5% again underlining the increased risk of polyvascular disease.

Objectives and scope of REACH

The overall aim of the REACH Registry is to improve the assessment and management of stroke, heart attack and associated risk factors for atherothrombosis. It is the largest and most geographically extensive global registry of patients at risk of atherothrombosis, having recruited over 68,000 patients in 44 countries, covering six regions -- Latin America, Asia, the Middle East, Australia, Europe and North America -- and involving over 5,000 physician investigators.(4,5)

The REACH Registry includes a broad spectrum of patients with atherothrombosis -- documenting the health status and treatment of people at risk of atherothrombosis; monitoring how they are affected; and measuring the burden of the disease. Patients included in the REACH Registry either have several of the risk factors that can lead to atherothrombosis, such as, high cholesterol, high blood pressure, smoking, and diabetes, or have a previous history of heart attack, stroke or PAD. Participation in the REACH Registry is strictly voluntary.

In addition, the REACH Registry is based in a real-life setting and seeks to increase overall understanding of atherothrombotic disease across several medical specialties (cardiology, neurology, internal medicine, vascular medicine and office-based primary care physicians), which allows for a more thorough assessment of the real-world burden of the disease.

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