International REACH Registry Verifies High Rates of Major Adverse Outcomes for Patients with Peripheral Arterial Disease (PAD)

In March 2007, the REACH Registry (Reduction of Atherothrombosis for Continued Health) published, in the Journal of the American Medical Association, a one-year study that highlighted the clinical outcomes for patients with atherothrombosis, including patients with peripheral arterial disease (PAD). The study showed that outpatients with atherothrombosis, although provided with ongoing care in physician office practices, continue to suffer surprisingly high rates of major cardiovascular events or death. Atherothrombosis occurs when a blood clot (a thrombus) forms on a ruptured plaque (atheroma) in the wall of a blood vessel. Plaques consist of fatty deposits and cholesterol, calcium, and other materials. The presence of plaque in many arteries throughout the body serves as the common thread linking heart attack, stroke, and PAD in individuals with atherothrombosis.

This large international Registry included more than 68,000 individuals to show that patients with PAD have a one in five (21%) chance of suffering a heart attack or stroke, being hospitalized, or dying due to cardiovascular complications within one year. If these patients with PAD also have artery disease in the heart and brain, the risk again doubles over the same period of time. These high-rates for heart attack, stroke and death in patients with PAD are equal to, or greater than, rates observed in individuals with coronary heart disease alone.

Who is at risk for PAD?
Everyone over 50 is at risk for PAD. However, your risk is increased if you:

• Smoke, or used to smoke
• Have diabetes
• Have high blood pressure
• Have abnormal blood cholesterol
• Are of African American ethnicity
• Have a personal history of vascular disease, heart disease, or stroke

The most common warning signs and symptoms of PAD include one or more of the following:

• Claudication—fatigue, heaviness, tiredness, or cramping in the leg muscles (calf, thigh, or buttocks) that occurs during activity such as walking and goes away when you rest.
• Foot or toe pain at rest that often disturbs sleep.
• Skin wounds or ulcers on the feet or toes that are slow to heal (or that do not heal for 8 to 12 weeks).

At least half of PAD patients do not have recognizable leg symptoms. Those who do have leg muscle discomfort often think it is a natural part of aging and do not tell their health-care provider. However, leg discomfort can be a sign that the leg arteries are already clogged.

See your doctor if you have any risk factors or symptoms. If you have PAD, getting treatment and taking action to reduce your risk may reduce your chances of having a heart attack or stroke. For more information about PAD, please visit www.vdf.org or contact us at 866.PAD.INFO to receive information by mail.

Reference: Steg G, Bhatt DL, Wilson PWF, D'Agostino R, Ohman EM, Rother J, Liau CS, Hirsch AT, Mas JL, Ikeda Y, Pencina MJ, Goto S, for the REACH Registry Investigators. One-Year Cardiovascular Event Rates in Outpatients with Atherothrombosis. JAMA. 2007; 297:1197-1206.