Higher-than-expected event rates among people with peripheral arterial disease (PAD) and poor adherence to statin therapy are the two principal findings from the most thorough
study of the impact of cardiovascular comorbidity in Australia.
Published in Monday’s MJA, one-year outcomes from the REACH registry study showed that the rate of clinical events in community-based patients with stable atherothrombotic disease increased dramatically with the severity of disease and the number of vascular beds involved.
The combined event-rate for vascular disease in one location was 11%, rising to 39% in patients with disease in three locations. After a year, 1.4% of the cohort had died from a cardiovascular event.
“For the first time we’ve been able to show that having these comorbidities really increases event rates, even after only one year,” lead author Professor Chris Reid of Monash University told Cardiology Update.
“There was really quite a dramatic increase in the rates of non-fatal heart attack, non-fatal stroke, and hospitalisation for CVD.”
The most noteworthy finding was the higher-than-expected event rate in people with peripheral arterial disease, Reid said. More than a fifth of PAD patients were hospitalised due to their condition, compared to around one in ten people with coronary artery or cerebrovascular disease.
The finding clearly indicated PAD needs to be more thoroughly addressed in general practice, where it is often under-recognised, Reid said.
Catching it early with a simple brachial index test could dramatically reduce risk, because “once it presents symptomatically, it’s too late – there is profuse vascular disease.”
There was a “treatment gap” in Australia, with therapy often failing to achieve the target levels associated with reducing risk, he said, specifically recommending greater adherence to statin therapy in secondary prevention.
The REACH registry recorded death and event rates in a cohort of 2873 Australians being managed for coronary artery disease, cerebrovascular disease, peripheral arterial disease, or at least three CVD risk factors.