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New data from real world evidence indicates need for better secondary prevention to reduce long-term ischaemic risk in heart attack survivors

Latest research highlights patients most at risk of future cardiovascular events

New data from three real-world evidence studies (PRECLUDE-2, TIGRIS and ATHENA), are presented today at the ESC Congress 2018 in Munich, Germany. The studies, supported by AstraZeneca, underline the ongoing and persistent risk of recurrent cardiovascular (CV) events and death in patients with diabetes or who have survived a heart attack.


The TIGRIS study highlights that even in patients with stable coronary artery disease (CAD), the risk of recurrent CV events remains constant over time1. These findings are consistent with the landmark analysis of the PEGASUS-TIMI 54 trial in which patients who had suffered an MI one to three years prior and who had additional risk factors, experienced a linear accumulation of CV events (CV death, MI or Stroke) during the follow-up period of three years.2


PRECLUDE-2, a Swedish registry study involving more than 100,000 patients, found that the majority of post-MI patients who have at least two cardiovascular disease risk factors, showed a marked but gradual increase in incidence of cardiovascular death, MI or stroke.3 If all five cardiovascular risk factors studied were present, there was up to a nine-fold increase in incidence of CV events, compared to when only one risk factor was present.3


Danilo Verge, Vice President, Medical Affairs, Cardiovascular, Renal and Metabolism at AstraZeneca, said: “An estimated seven million people worldwide experience a potentially fatal heart attack every year. For those who survive, it is often the start of a journey into declining cardiovascular health. Results from PRECLUDE-2 study demonstrate that long-term CV risk is particularly pronounced for heart attack survivors with additional risk factors. These findings can help physicians identify patients who are most likely to benefit from secondary prevention therapies.”


The cardiovascular risk in patients with type-2 diabetes specifically is investigated further in the ATHENA study involving more than 300,000 patients. The results demonstrate that diabetic patients who also have CAD, or who have experienced a prior heart attack or a stroke, are at greater risk of future cardiovascular death, heart attack and stroke than patients with just diabetes alone.4 The increased risk was primarily due to an increased risk of myocardial infarction, highlighting a need for better secondary prevention therapies in these patients.


The studies, supported by AstraZeneca, and presented at ESC Congress 2018 this year highlight our continued commitment to supporting the generation of new scientific evidence and pursuing our aim of delivering leading science that addresses patient needs across the global burden of these conditions.

Below, please find more detailed information on the studies.

*please see “Note to Editors” for complete study details



Study population

Key findings

PRECLUDE-2: Registry / observational study3


  • More than 100,000 patients from the SWEDEHEART Patient Registry who had been hospitalised for a heart attack and managed invasively.
  • The majority of patients had at least two risk factors for future CV events, with greater numbers of risk factors resulting in greater risk.


  • More than 20,000 patients (20.6 percent) experienced either another heart attack, stroke or CV death during a median follow-up of 3.6 years.3


TIGRIS1: Global prospective registry study involving 369 centres in 25 countries


·         More than 9,000 high-risk stable coronary artery disease (CAD)  patients with at least one of the following risk factors aged 65 years or over, diabetes mellitus, a second prior MI, multi-vessel CAD, chronic kidney dysfunction (CKD), were.evaluated for long-term progression of atherothrombotic disease.


·      6.9 percent of patients had a recurrent CV event (MI, unstable angina with urgent revascularisation, stroke, or death from any cause) over two years with a linear accumulation of events throughout follow-up period.

·      The presence of risk factors including diabetes and an additional prior MI were independently associated with increased risk of CV events.


ATHENA4: Swedish National Registry observational study


More than 300,000 patients with type-2 diabetes treated with glucose-lowering drugs between 2006–2013.

Patients with diabetes who also have CAD, or who have experienced a prior heart attack or a stroke, are at greater risk of a future cardiovascular death, heart attacks or strokes than patients with just diabetes alone (2 years cumulative incidence 9.94% vs 6.26% vs. 4.55%). The higher risk seen in diabetic patients with CAD vs. without CAD was primarily driven by the risk of MI.


Editor Details

Last Updated: 29-Aug-2018