Abstract 13420: A History of Stable Angina Significantly Increases the Risk of Cardiovascular Death and Myocardial Infarction in the REACH Registry
Background: Patients with stable angina (SA) have reduced quality of life and utilize greater health-care resources. However, the relative risks of cardiovascular (CV) events among patients with and without angina are not well described.
Methods: Outpatients with coronary artery disease, cerebrovascular disease, or peripheral artery disease or with multiple risk factors for atherothrombosis were enrolled in 29 countries in the global REACH Registry and were followed for up 4 years. For this analysis, patients were classified into 3 groups: 1) multiple risk factors alone (n=7977, 17.8%), 2) established CV disease without a history of SA (n=23,140, 51.7%), and 3) established CV disease with a history of SA (n=12,591, 30.4%). SA was defined as necessitating episodic or permanent medication use.
Results: Compared to pts without SA, those with any history of SA were more likely to be older, have diabetes, polyvascular disease, history of coronary revascularization, and be treated with cardiac medications. The risk of CV death and MI increased in stepwise fashion from patients with risk factors alone (6.2%), cardiovascular disease without SA (10.2%), and history of SA (12.2%). (Figure) The risk associated with SA was more than 2X higher than patients with multiple risk factors and >20% higher than patients with asymptomatic CV disease, even after controlling for baseline characteristics. A similar pattern was observed for coronary revasc (1.6 v. 2.9 v. 4.6%, respectively) and heart failure. (1.6 v. 2.5 v. 5.0%) Patients with angina were also more likely to require hospitalization for CV causes (2.9 v. 5.0 v. 7.5%, respectively, p<0.01).
Conclusion: The presence of stable angina increased the risk of recurrent ischemic events such as CV death/MI or revascularization when compared with patients with risk factors alone, or with patients with established CV disease but no SA. Careful assessment for any symptoms of SA identifies pts at high risk of cardiovascular complications.
- © 2011 by American Heart Association, Inc.