ESC: Global rates of recurring heart attacks, strokes still surprisingly high
Despite many medicines and other treatments for patients with vascular disease, an international study presented Monday at the 2009 European Society of Cardiology Congress (ESC) in Barcelona, Spain, shows that these patients have a surprisingly high rate of recurring events such as strokes, heart attacks and hospitalizations, as well as mortality.

Also unexpected in the findings is that patients in North America, including the U.S., experienced an above-average rate of these events. Patients in Eastern Europe had the highest rate, and those in Australia and Japan had the lowest.

The REACH (Reduction of Atherothrombosis for Continued Health) Registry, presented by lead author Mark J. Alberts, MD, director of the stroke program at Northwestern Memorial Hospital in Chicago, examined data for 32,247 patients, one and three years after they enrolled in the registry.

The researchers found that patients who had symptomatic vascular disease had a 14.4 percent rate at one year and 28.4 percent rate at three years of having a heart attack, stroke, rehospitalization for another type of vascular event or vascular death. Patients with vascular disease in more than one location of the body had the highest event rate at 40.5 percent at three years.

When projected over the global population that would mirror the patients in REACH, this represents millions of serious vascular events occurring every few years, many of which could be prevented, the authors noted.

"We were surprised by the high rate of these recurring vascular events," said Alberts. "We know how to prevent vascular disease and the events that it produces. This [finding] points to the need for better prevention, better use of medications and a need to develop more potent medications. These are the number one and two causes of death throughout the world."

Alberts and colleagues also found that between 19 percent and 33 percent of patients were re-hospitalized for a vascular event other than a recurrent stroke, heart attack or vascular death. Since hospitalization is a major driving factor in healthcare costs, any steps to reduce the rate of hospitalization would have a positive impact on reducing healthcare expenses.

The REACH investigators also noted that recurring vascular events cost billions of dollars annually in the U.S. The cost of heart attacks, angina or related conditions in the U.S. is $150 billion, of which 60 percent is related to hospitalization. The annual cost of these conditions in Germany is EU3.3 billion ($4.71 billion U.S.) and in Italy, EU3.1 billion ($4.43 billion U.S.).

Many of the patients in the REACH study, which was simultaneously published in the European Heart Journal, were taking the appropriate medications for their vascular disease, the researchers reported.

"But that doesn't mean the medications worked or were being adhered to properly," Alberts said. "Perhaps they need more or different medications."

He said this study shows the need for more patients to adopt healthier lifestyles with increased exercise, a healthy diet and smoking cessation—as they are inexpensive approaches to reducing and preventing the occurrence of vascular events.

The REACH Registry is funded by the New York City-based Bristol-Myers Squibb, the Paris-based Sanofi-Aventis and the Waksman Foundation in Japan. The REACH registry also is endorsed by the World Heart Federation.