CCRE Therapeutics, Monash University, Melbourne, VIC, Australia.
Med J Aust. 2012 Feb 20;196(3):193-7. doi: 10.5694/mja11.10731.
To report on 1-year cardiovascular (CV) event rates in patients with established cardiovascular disease (CVD) or with multiple cardiovascular risk factors.
DESIGN, PATIENTS AND SETTING: Prospective cohort study of 2873 patients at high risk of atherothrombosis based on the presence of multiple risk factors and overt coronary artery disease (CAD), cerebrovascular disease (CerVD) or peripheral arterial disease (PAD) presenting to 273 Australian general practitioners; this study was conducted as part of the international REACH Registry.
One-year rates of cardiovascular death, myocardial infarction, stroke, and hospitalisation for cardiovascular procedures.
The cardiovascular death rate at 1 year was 1.4%. The combined cardiovascular death, non-fatal MI, stroke and hospitalisation rate for vascular disease affecting one location at 1 year was 11%. Even for patients with no overt disease, but with multiple risk factors, the 1-year combined event rate was 4.2%. The highest combined event rate was in patients with PAD (21.0%), and in patients with atherothrombotic disease identified in all three locations (coronary arteries, cerebrovascular system and peripheral arteries) at 39%.
The rate of clinical events in community-based patients with stable atherothrombotic disease increases dramatically with the severity of disease and the number of vascular beds involved. Where disease was evident in all three locations, and for patients with PAD alone, the 1-year risk of cardiovascular events was substantially increased. Poor adherence to statin therapy in the secondary preventive setting is a major treatment gap that needs to be closed; the influences of obesity and diabetes warrant further investigation.
报告患有已确诊心血管疾病（CVD）或存在多种心血管危险因素患者的 1 年心血管（CV）事件发生率。
设计、患者和设置：对 273 名澳大利亚全科医生就诊的 2873 名高动脉粥样硬化血栓形成风险患者（基于存在多种危险因素和明显冠状动脉疾病（CAD）、脑血管疾病（CerVD）或外周动脉疾病（PAD））进行前瞻性队列研究；这项研究是国际 REACH 登记研究的一部分。
心血管死亡、心肌梗死、卒中和心血管程序住院的 1 年发生率。
1 年时心血管死亡率为 1.4%。1 年时，影响一个部位的心血管死亡、非致死性心肌梗死、卒中和血管疾病住院的复合发生率为 11%。即使对于没有明显疾病但存在多种危险因素的患者，1 年的复合事件发生率也为 4.2%。PAD 患者的复合事件发生率最高（21.0%），在冠状动脉、脑血管系统和外周动脉三个部位均存在动脉粥样硬化血栓形成疾病的患者中，复合事件发生率最高（39%）。
在稳定的动脉粥样硬化血栓形成疾病的社区患者中，临床事件的发生率随着疾病的严重程度和受累血管床数量的增加而显著增加。在三个部位均存在疾病的情况下，以及 PAD 患者中，1 年心血管事件的风险显著增加。在二级预防环境中他汀类药物治疗的依从性差是一个主要的治疗差距，需要加以解决；肥胖和糖尿病的影响值得进一步研究。
