First Baseline Data by REACH Supports and Extends ESC’s Euroaspire Findings

While there are clear guidelines about the best way to treat cardiovascular risk factors such as high blood pressure and high cholesterol, the first large scale global study on cardiac care has revealed that there is a gap between what is recommended and what is practiced worldwide.

The study, published in the Journal of the American Medical Association (JAMA)(1), 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.

The European Society of Cardiology’s (ESC) Euroaspire I and II surveys (2) 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 MI 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 Professor 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 hypercholesterolaemia. The findings validate the ESC’s explicit policy of total cardiovascular risk estimation and management, rather than focusing on single risk factors.”

The REACH study also revealed that the type of treatment patients received depended on the specialty of the physician. Cardiologists, for example, prescribed statins significantly more often than physicians with other specialties.

“The findings stress the need for the appropriate and judicious use of appropriate drugs, such as statins, anti-hypertensive drugs and anti-platelet agents,” said Professor Graham. “Above all, the findings indicate the urgent need to promote a cultural change that favours physical activity, the avoidance of being overweight and the consequent avoidance of diabetes, together with a culture that avoids tobacco. Such an approach would inevitably have beneficial consequences on blood pressure and blood cholesterol control.”

The study’s results underline the need for more comprehensive and wide-spread risk assessment. This is being facilitated by the 4th Joint Task Force guidelines on prevention which, through the participation of the European Stroke initiative, will address the prevention of stroke as well as coronary heart and peripheral vascular disease. Guidance without practical implementation is of limited value, and the ESC’S Joint Prevention Committee is developing strategies to facilitate the dissemination and implementation of the Task Force guidelines.

The ESC is working on Euroaspire III (3), 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 Professor Graham. “The European Society of Cardiology, through its mission statement, is dedicated to facilitating these changes.”

(1) JAMA, January 11, 2006 – Vol 295, No. 2

(2) The Euroaspire I survey was undertaken by the Working Group on Epidemiology and Prevention of the European Society of Cardiology in 9 European countries. For more information see: http://www.escardio.org/knowledge/ehs/survey/previous_research_projects.htm

Euroaspire II’s goal was to understand the how effectively patients’ risk factors were being managed in comparison to the goals for coronary prevention set out in the 1998 Joint European Societies Recommendations on Coronary Prevention in Clinical Practice and are published in the European Heart Journal. http://www.escardio.org/knowledge/ehs/survey/EUROASPIREII.htm

(3) Eurospire III This third multi-centre European study will identify risk factors in coronary patients, their blood relatives and high risk individuals in the healthy population and describe their management. For more information see; http://www.escardio.org/knowledge/ehs/survey/