Greater focus on artery disease needed globally

Patients with established artery plaques often have classic cardiovascular risk factors, such as high blood pressure, high cholesterol, diabetes, and obesity - not to mention smoking - that often go untreated and uncontrolled, an international study shows.

"Even in the current era, patients at risk for (heart attack and stroke) are not being treated with medical therapy...with the intensity that randomized clinical trial data would support," said Dr. Deepak L. Bhatt from the Cleveland Clinic Foundation in Ohio.

Bhatt and colleagues analyzed data from The Reduction of Atherothrombosis for Continued Health (REACH) Registry, an ongoing, international effort to determine the prevalence of risk factors, treatment patterns, and the rate of recurrent events in patients with artery disease affecting the heart, brain, or other regions.

The database includes 67,888 patients ages 45 years or older from 5,473 physician practices in 44 countries.

Overall, most patients had high blood pressure and high cholesterol levels and a large proportion had diabetes, the team reports in the Journal of the American Medical Association.

The rate of obesity was similar in most geographic locales, but was highest in North America. Regardless of locale, a substantial number of patients smoked.

Bhatt's team observed that, in general, patients were undertreated with medications shown to reduce the risk of heart attack and stroke, such as the popular cholesterol-lowering statin drugs, like Zocor and Mevacor.

Bhatt said, "future efforts should be directed at understanding the barriers to" implementing guidelines designed to reduce the risk of heart attack and stroke in patients with arterial disease.

SOURCE: Journal of the American Medical Association, January 11, 2006.