Risk factor profile and treatment patterns of patients with atherothrombosis in Singapore: Insight from the REACH registry

Abstract

Introduction: Atherothrombosis is the leading cause of cardiovascular mortality. The Reduction of Atherothrombosis for Continued Health (REACH) Registry provided information on atherosclerosis risk factors and treatment. Singapore was one of the 44 participating countries in the REACH Registry. The objective of this study was to determine the atherosclerosis risk factor profile and treatment patterns in Singapore patients enrolled in the REACH Registry. Materials and Methods: The REACH Registry is an international prospective observational registry of subjects with or at risk for atherothrombosis. Patients aged 45 years or older with established vascular disease [coronary artery disease (CAD), cerebrovascular disease (CVD), peripheral arterial disease (PAD)] or 3 or more atherosclerosis risk factors were recruited between 2003 and 2004. Results: A total of 881 patients (64.4% male) were recruited in Singapore by 63 physicians. The mean age was 64 ± 9.8 years (range, 45 to 95). Seven hundred and one (79.6%) patients were symptomatic (CAD 430, CVD 321, PAD 72) while 180 (20.4%) patients had ≥3 risk factors. Approximately 13% of symptomatic patients had symptomatic polyvascular disease. There was a high proportion of diabetes mellitus (57%), hypertension (80.6%) and hypercholesterolemia (80.1%). A substantial proportion of symptomatic patients were current smokers (14.1%). Approximately half of the patients were either overweight or obese [abdominal obesity, 54.3%; body mass index (BMI) 23-27.5, 45.9%; BMI ≥27.5, 23.3%]. Patients were undertreated with antiplatelet agents (71.9% overall; range, 23.9% for ≥3 risk factors to 84.7% for PAD) and statins (76.2% overall; range, 73.6% for PAD to 82.1% for CAD). Risk factors remained suboptimally controlled with a significant proportion of patients with elevated blood pressure (59.4% for ≥3 risk factors and 48.6% for symptomatic patients), elevated cholesterol (40% for ≥3 risk factors and 24.4% for symptomatic patients) and elevated blood glucose (45% for ≥3 risk factors and 19.8% for symptomatic patients). Conclusion: Established atherosclerosis risk factors are common in Singapore patients in the REACH Registry; and obesity is a major problem. Most of these risk factors remained suboptimally controlled.