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Effects of adherence to guidelines for the control of major cardiovascular risk factors on outcomes in the REduction of Atherothrombosis for Continued Health (REACH) Registry Europe
  1. Patrice P Cacoub1,
  2. Uwe Zeymer2,
  3. Tobias Limbourg2,
  4. Iris Baumgartner3,
  5. Don Poldermans4,
  6. Joachim Röther5,
  7. Deepak L Bhatt6,
  8. Philippe Gabriel Steg7 on behalf of the REACH Registry Investigators*
  1. 1INSERM U959, UMR 7211 Pierre and Marie Curie University-Paris 6, and AP HP, Hospital La Pitié-Salpêtrière, Paris, France
  2. 2Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen, Germany
  3. 3Swiss Cardiovascular Centre, Division of Clinical and Interventional Angiology, Inselspital, University Hospital, Berne, Switzerland
  4. 4Department of Vascular Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
  5. 5Johannes Wesling Klinikum Minden, Hannover Medical School, Hannover, Germany
  6. 6VA Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
  7. 7INSERM U-698, Université Paris 7 and AP-HP, Paris, France
  1. Correspondence to Professor Patrice Cacoub, AP HP Service de Médecine Interne, Groupe Hospitalier La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75013 Paris, France; patrice.cacoub{at}


Objectives To examine the impact of cardiovascular risk factor control on 3-year cardiovascular event rates in patients with stable symptomatic atherothrombotic disease in Europe.

Methods The REduction of Atherothrombosis for Continued Health (REACH) Registry recruited patients aged ≥45 years with established atherothrombotic disease or three or more risk factors, of whom 20 588 symptomatic patients from 18 European countries were analysed in this study at baseline and 12, 24 and 36 months. ‘Good control’ of cardiovascular risk factors was defined as three to five risk factors at target values of international guideline recommendations (systolic blood pressure <140 mm Hg, diastolic blood pressure <90 mm Hg, fasting glycaemia <110 mg/dl, total cholesterol <200 mg/dl, non-smoking). Independent predictors of ‘good control’ of major risk factors were assessed by multivariate analysis.

Results Among symptomatic patients in the REACH Registry Europe (mean age 67 years, 70.6% male), 59.4% had good control of risk factors at baseline. Good risk factor control was associated with lower cardiovascular death/non-fatal stroke/non-fatal myocardial infarction (OR 0.76; 95% CI 0.69 to 0.83) and mortality (OR 0.89; 95% CI 0.79 to 0.99) at 36 months, compared with poor control. Independent predictors of good control of risk factors included residence in western versus eastern Europe (OR 1.29), high level of education (OR 1.16), established coronary artery disease (OR 1.18), treatment with one or more antithrombotic (OR 1.59) and one or more lipid-lowering agent (OR 1.16).

Conclusions In REACH, less than 60% of patients with stable atherothrombotic disease had good control of the five major cardiovascular risk factors. Improved risk factor control is associated with a positive impact on 3-year cardiovascular event rates and mortality.

  • Atherosclerosis
  • atherothrombotic disease
  • cardiovascular events
  • cohort study
  • diabetes
  • epidemiology
  • lipids
  • primary care
  • REACH Registry
  • risk factor control

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  • * A complete list of REACH Registry Investigators appears in the appendix.

  • Funding The REACH Registry is sponsored by Sanofi-Aventis (Paris, France), Bristol-Myers Squibb (Princeton, New Jersey, USA) and the Waksman Foundation (Tokyo, Japan). The sponsors provide logistical support. All manuscripts in the REACH Registry are led by independent authors who are not governed by the funding sponsors and are reviewed by an academic publication committee before submission. The funding sponsors have the opportunity to review manuscript submissions but do not have authority to change any aspect of a manuscript.

  • Competing interests PPC has received research grants from Sanofi-Aventis, Schering Plough, Servier and Roche; honoraria from Sanofi-Aventis, Schering Plough, Servier, Roche, AstraZeneca and Bristol-Myers Squibb. UZ has received research grants and speaker honoraria from Bristol-Myers-Squibb and Sanofi Aventis. JR has received honoraria and consulting fees from Sanofi-Aventis, Bristol-Myers Squibb, Lundbeck and Boehringer Ingelheim. DLB has received research grants (to the institution) from: AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Heartscape, Sanofi-Aventis and The Medicines Company; has served as a consultant (honoraria waived or donated for past three years) for Arena, Astellas, AstraZeneca, Bayer, Bristol-Myers Squibb, Cardax, Centocor, Cogentus, Daiichi-Sankyo, Eisai, Eli Lilly, GlaxoSmithKline, Johnson & Johnson, McNeil, Medtronic, Millennium, Molecular Insights, Otsuka, Paringenix, PDL, Philips, Portola, Sanofi-Aventis, Schering Plough, Scios, Takeda, The Medicines Company and Vertex. PGS has received a research grant from Sanofi-Aventis (1999 to 2008); is on the speaker's bureau for Boehringer-Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Menarini, Medtronic, Nycomed, Pierre Fabre, Sanofi-Aventis, Servier and The Medicines Company; is on the consulting/advisory boards for Astellas, AstraZeneca, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, Daiichi-Sankyo, Endotis, GlaxoSmithKline, Medtronic, MSD, Nycomed, Sanofi-Aventis, Servier and The Medicines Company and is a stockholder for Aterovax. TL, IB and DP: No interests declared.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Paris University.

  • Provenance and peer review Not commissioned; externally peer reviewed.