JAMA Logo Atherothrombosis is known to be characterized by atherosclerotic lesion disruption with superimposed thrombus formation and is apparently the major cause of acute coronary syndromes (ACS) and cardiovascular death. Now, clinical descriptors can help clinicians in evaluating patients with varying stages of atherothrombosis who are at a greater risk of potential cardiovascular events.

Experts examined 45,227 patients who participated in the global Reduction of Atherothrombosis for Continued Health (REACH) study. Scientists collected adequate data at baseline with periodic follow-up at one, two, three and four years. Patients enlisted for the study enrolled between 2003 and 2004, however the follow-up prolonged till 2008.

“Patients with atherothrombosis are at elevated risk of ischemic events but, depending on their specific manifestations of atherothrombosis, may have varying degrees of future risk for ischemic events. For clinicians, the ability to identify rapidly the major determinants of risk among patients with atherosclerosis would be useful to triage novel preventive therapies toward those at the higher end of the spectrum, authors remarked.

Experts identified that hypertension and hypercholesterolemia was common and present in 81.3 percent and 70.4 percent of patients respectively. They also revealed that polyvascular disease was present in 15.9 percent of patients and 48.4 percent had prior ischemic events, with 28.1 percent of those having an ischemic event within the previous year.

“Among all categories of patients, diabetes substantially increased the risk of future ischemic events,” the authors commented. “In those with established atherothrombosis, polyvascular disease was a particularly strong independent risk factor, even stronger than diabetes.” Additionally, the authors conclude that, “this analysis of a contemporary, international cohort of patients at various stages of atherothrombosis shows that there is a whole spectrum of ischemic risk in patients with risk factors or with established cardiovascular disease and that easily ascertainable clinical characteristics are the prominent factors associated with a high risk of future ischemic events.”

Around 5,481 patients experiencing cardiovascular events. Approximately 2,315 participants reported cardiovascular deaths, 1,228 with myocardial infarction, 1,898 with stroke and around 40 individuals reported both myocardial infarction and stroke occurring on the same day. Scientists also observed that patients with atherothrombosis who had a prior history of ischemic events at baseline experienced the highest rate of subsequent ischemic events. Individuals with stable coronary, cerebrovascular or peripheral artery disease had minimal risk. Patients without atherothrombosis but with risk factors had minimal risk of consequent ischemic events.

These findings will be published in the September 22 issue of JAMA.