An international study of clinical data led by a Department of Veterans Affairs (VA)-Harvard University cardiologist found that patients with deposits of fatty plaque in their arteries are at especially high risk for life-threatening cardiovascular events if they have diabetes, disease in multiple arteries or a history of heart attack or stroke.
“The results, presented both in a prestigious medical journal and at a major international cardiology meeting, are likely to be of great significance to physicians—particularly cardiologists—in VA and worldwide.”
"This study was an impressive international collaboration that may hold important clinical benefits for Veterans and others with cardiovascular disease," said VA Secretary Eric K. Shinseki. "The results, presented both in a prestigious medical journal and at a major international cardiology meeting, are likely to be of great significance to physicians—particularly cardiologists—in VA and worldwide."
The findings, from a study of more than 45,000 patients in nearly 30 countries, was published online August 30 by the Journal of the American Medical Association and will appear in the journal's September 22 print edition. The results are also being presented this week at the annual meeting of the European Cardiology Society in Sweden.
According to lead author Dr. Deepak Bhatt and colleagues, the findings may guide future clinical trials and help doctors decide which patients need more aggressive treatment. Bhatt is chief of cardiology at the VA Boston Healthcare System and director of the Integrated Interventional Cardiovascular Program at VA and Brigham and Women's Hospital, a teaching affiliate of Harvard Medical School.
The four-year study included patients who had at baseline clinical evidence of atherothrombosis—in which fatty deposits break off from artery walls to form clots—or who had risk factors for the condition. Ruptured plaque deposits can form clots that block blood flow to the heart or brain, resulting in heart attack or stroke.
Depending on their medical status and history, different groups of patients in the trial were at higher or lower risk for stroke, heart attack, or cardiovascular death. On the low end of the risk scale—7 percent—were those with no diabetes and only risk factors for atherothrombosis. The risk rose to as high as 25 percent for those with clinical evidence of atherothrombosis in multiple arteries and a history of heart attack or stroke. The presence of diabetes also raised the risk considerably.
"Even stable patients with a previous heart attack or stroke are at particularly high risk of recurrence if they have plaque build-up in several different arteries or if they have diabetes," said Bhatt. "These types of patients need aggressive preventive efforts to keep history from repeating itself."
Knowing that "not all atherothrombosis is equal," write Bhatt and colleagues, can help doctors target therapies such as plaque-reducing and clot-busting drugs to those patients who will benefit most. VA Chief Research and Development Officer Dr. Joel Kupersmith adds, "this study illustrates the importance of basic clinical information in determining the best care for the individual patient."
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