Aims: To evaluate the influence of achieving secondary prevention target treatment goals for cardiovascular (CV) risk factors on clinical outcomes in patients with prior coronary artery bypass surgery (CABG). Methods and results: Accordingly, we analysed treatment to target goals in patients with prior CABG and atherothrombotic disease or known risk factors (diabetes, hypertension, hypercholesterolaemia, smoking, obesity) enrolled in the global REduction in Atherothrombosis for Continued Health (REACH) Registry, and their association with 1 year outcomes. A total of 13 907 of 68 236 patients (20.4%) in REACH had a history of prior CABG, and 1 year outcomes data were available for 13 207 of these. At baseline <25, 25-<50, 50-<75, and ≥75% risk factors were at goal in 3.7, 12.9, 31.7, and 51.7% of patients, respectively. One-year composite rates of CV death, non-fatal MI, non-fatal stroke were inversely related to the proportion of risk factors at goal at baseline (age, gender, and region adjusted rates 6.1, 5.6, 5.2, and 4.3% of patients with <25, 25-<50, 50-<75, and >75% risk factors at goal, respectively; P for trend 0.059). Conclusion: Risk-factor control varied greatly in CABG patients. Although CABG patients are frequently treated with appropriate therapies, these treatments fail to achieve an adequate level of prevention in many. This failure was associated with a trend for worse age-, gender-, and region-adjusted clinical outcomes. Thus, perhaps secondary prevention after CABG needs to focus on more comprehensive modification of risk factors to target goals in the hope of preventing subsequent CV events, and represents an opportunity to improve CV health.
Bibliographical noteFunding Information:
D.L.B. discloses the following relationships: Research Grants (directly to the institution)—Bristol-Myers Squibb, Eisai, Ethicon, sanofi-aventis, The Medicines Company; Honoraria (donated to non-profits for .2 years)—AstraZeneca, Bristol Myers Squibb, Centocor, Daiichi-Sankyo, Eisai, Eli Lilly, Glaxo Smith Kline, Millennium, Paringenix, PDL, Sanofi Aventis, Schering Plough, The Medicines Company, TNS Healthcare; Speaker’s Bureau (.2 years ago)—Bristol-Myers Squibb, sanofi-aventis, The Medicines Company; Consultant/Advisory Board (any honoraria donated to non-profits)—AstraZeneca, Bristol-Myers Squibb, Cardax, Cento-cor, Cogentus, Daiichi-Sankyo, Eisai, Eli Lilly, Glaxo Smith Kline, Johnson & Johnson, McNeil, Medtronic, Millennium, Otsuka, Parin-genix, PDL, Philips, Portola, Sanofi Aventis, Schering Plough, The Medicines Company, TNS Healthcare, Vertex; Expert testimony regarding clopidogrel (the compensation was donated to a nonprofit organization). P.G.S. has received honoraria for advisory board attendance and consulting fees from AstraZeneca, Boehringer-Ingelheim, Bristol-Myers Squibb, Glaxo Smith Kline, Merck Sharpe and Dohme, Nycomed, sanofi-aventis, Servier, Takeda, The Medicines Company; Speakers Bureau from Boehringer-Ingelheim, Bristol-Myers Squibb, Glaxo Smith Kline, Nycomed, sanofi-aventis, Servier, ZLB Behring, and research grant from sanofi-aventis within the last 3 years.
The REACH Registry is sponsored by sanofi-aventis (Paris, France), Bristol-Myers Squibb (Princeton, NJ, USA), and the Waksman Foundation (Tokyo, Japan), and endorsed by the World Heart Federation. The sponsors provide logistical support. All the publication activity is controlled by the REACH Registry Global Publication Committee (Ph. Gabriel Steg, Deepak L. Bhatt, Mark Alberts, Ralph D’Agostino, Kim Eagle, Shinya Goto, Alan T. Hirsch, Chiau-Suong Liau, Jean-Louis Mas, E. Magnus Ohman, Joachim Röther, Sidney C. Smith, Peter W.F. Wilson). All manuscripts in the REACH Registry are prepared by independent authors, who are not governed by the funding sponsors, and are reviewed by an academic publications 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.
P.W.F.W. has received research grants from sanofi-aventis and other research support from GlaxoSmithKline. A-J.R. is an employee of sanofi-aventis.
E.M.O. has received research grants from Bristol Myers Squibb, sanofi-aventis, Schering-Plough, Millennium, Eli Lillie, and Berlex. He receives consulting fees from Inovise, Savacor, Liposcience, Response Biomedical, The Medicines Company, Datascope, and Abiomed, and is on the Speaker Bureau of CV Therapeutics and Schering Plough. He is also a stockholder in Inovise, Savacor, and Medtronics.
K.A.E. has received research grant support from Biosite, Bristol-Myers Squibb, Cardiac Sciences, Blue Cross Blue Shield of Michigan, Hewlett Foundation, Mardigian Fund, Pfizer, sanofi-aventis, Varbedian Fund, and consulting fees for NIH NHLBI, Pfizer, sanofi-aventis, Robert Wood Johnson Foundation.
S.G. has received honoraria and consulting fees from Eisai, sanofi-aventis, Daiichi-Sankyo, GlaxoSmithKline, Bristol-Myers Scribb, Otsuka, Bayer, Schering-Plough, Takeda, Astellas, AstraZe-neca, Novartis and Kowa. He has also received research grants from Pfizer, Ono, Eisai, Otsuka, Daiichi-Sankyo, sanofi-aventis, Takeda, and Astellas within the last 3 years.
- Coronary disease
- Risk factors