Objective To clarify the differences in the baseline characteristics, prevalence and incidence of atherothrombosis in patients recruited from Asia versus non-Asian regions.
Design International Prospective Cohort Study.
Setting Region focused substudy.
Patients The Reduction of Atherothrombosis for Continued Health (REACH) Registry recruited 68 236 stable outpatients with established atherothrombosis or ≥3 atherothrombotic risk factors from 44 countries.
Interventions No intervention.
Main outcome measures Risk factors, use of medications, vascular disease bed location, and 1-year cardiovascular (CV) outcomes (CV death, myocardial infarction, stroke).
Results The percentages of patients recruited with CVD (Cerebrovascular Disease) were higher in Asia (41.0%) than in non-Asian regions (25.1%) (p<0.0001). The prevalence of diabetes mellitus was higher in Asia (46.6%) than in non-Asian regions (43.3%) (p<0.0001) despite the former having a lower body mass index (BMI) (24.4±3.9 vs 28.8±5.6) (p<0.0001). The combined endpoint of CV death/myocardial infarction/stroke of patients recruited from non-Asian regions of 4.38% (95% CI 4.20 to 4.56) is equivalent to those from the Asian region excluding Japan of 4.65% (95% CI 4.04 to 5.25), but that is significantly lower in patients recruited from Japan of 3.40% (95% CI 2.76 to 4.04, p<0.05).
Conclusions There is a higher prevalence of CVD and higher prevalence of diabetus mellitus with lower body mass index in patients recruited from the Asian region as compared those recruited from non-Asian regions. The CV event rate in patients recruited from non-Asian regions is equivalent to that of patients recruited from the Asian region excluding Japan, but significantly lower in patients recruited from Japan.
- geographic variation
- risk factor
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Funding The REACH Registry is sponsored by Sanofi-Aventis, Bristol-Myers Squibb and the Waksman Foundation (Tokyo). The REACH Registry is endorsed by the World Heart Federation. A complete list of REACH investigators is accessible online at http://www.reachregistry.org. The REACH Registry enforces a no ghost-writing policy.
Competing interests SG has received honoraria and consulting fees from Eisai, Sanofi-Aventis, Daiichi-Sankyo, GlaxoSmithKline, Bristol-Myers Squibb, Otsuka, Bayer, Schering-Plough, Takeda, Astellas, AstraZeneca, Novartis and Kowa. SG also received research grants from Pfizer, Ono, Eisai, Otsuka, Daiichi-Sankyo, Sanofi-Aventis, Takeda and Astellas within the last 3 years. YI has received honoraria or donations from Sanofi-Aventis, Daiichi-Sankyo and Bayer. JCNC has received consultancy fees or research grants or donations from Sanofi-Aventis, Bayer, MSD, Lilly, Pfizer, AstraZeneca, Bristol-Myers Squibb and GlaxoSmithKline. All proceeds go to The Chinese University of Hong Kong to support ongoing research and education programmes in diabetes and related disease. PWFW has received grant support from Sanofi-Aventis. TCY has received an honorarium from Sanofi-Aventis. MTBA has received honoraria from Sanofi-Aventis, Pfizer, Otsuka and Bayer, is a member of an advisory board sponsored by Sanofi-Aventis and has received study grants from AstraZeneca, Boehringer-Ingelheim, Mayer, MSD, Otsuka, Pfizer, Sanofi-Aventis and Servier. PGS discloses the following relationships: Research Grant: Sanofi-Aventis (significant); speakers of bureau (all modest): Boehringer-Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Medtronic, Nycomed, Sanofi-Aventis, Servier, The Medicines Company; Consulting/advisory board (all modest): Astellas, AstraZeneca, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, Endotis, GlaxoSmithKline, Medtronic, MSD, Nycomed, Sanofi-Aventis, Servier, The Medicines Company. Stockholding: none. G Salette is an employee of Sanofi-Aventis. DLB discloses the following relationships: honoraria (donated to non-profits for >2 years) AstraZeneca, Bristol Myers Squibb, Centocor, Daiichi-Sankyo, Eisai, Eli Lilly, GlaxoSmithKline, Millennium, Paringenix, PDL, Sanofi-Aventis, Schering Plough, The Medicines Company, TNS Healthcare; speakers of bureau (>2 years ago) Bristol Myers Squibb, Sanofi-Aventis, The Medicines Company; Consultant/Advisory Board (any honoraria donated to non-profits) AstraZeneca, Bristol Myers Squibb, Cardax, Centocor, Cogentus, Daiichi-Sankyo, Eisai, Eli Lilly, GlaxoSmithKline, Johnson & Johnson, McNeil, Medtronic, Millennium, Otsuka, Paringenix, PDL, Philips, Portola, Sanofi-Aventis, Schering Plough, The Medicines Company, TNS Healthcare, Vertex; expert testimony regarding clopidogrel (the compensation was donated to a non-profit organisation).
Patient consent Obtained.
Ethics approval Ethics approval was provided by the approval of the study by the institutional review board in each 44 country or hospital according to local requirements.
Contributors The first draft was written by SG. SG had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. SG, YI, JCNC, TCY, CSL and MTBA were responsible for the study concept and design, and acquisition of data. PWFW was responsible for the analysis and interpretation of data. SG, YI, PWFW, PGS and DLB were responsible for the drafting of the manuscript. All authors were involved with the critical revision of the manuscript for important intellectual content. G Salette was responsible for the statistical analysis. PGS and DLB obtained funding for the study and provided administrative, technical or material support, and study supervision.
Provenance and peer review Not commissioned; externally peer reviewed.
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