TY - JOUR
T1 - Association of Traditional Cardiovascular Risk Factors with Venous Thromboembolism
T2 - An Individual Participant Data Meta-analysis of Prospective Studies
AU - Mahmoodi, Bakhtawar K
AU - Cushman, Mary
AU - Næss, Inger Anne
AU - Allison, Matthew A
AU - Bos, Willem Jan
AU - Brækkan, Sigrid K
AU - Cannegieter, Suzanne
AU - Gansevoort, Ron T
AU - Gona, Philimon N
AU - Hammerstrøm, Jens
AU - Hansen, John-Bjarne
AU - Heckbert, Susan
AU - Holst, Anders G
AU - Lakoski, Susan G
AU - Lutsey, Pamela L
AU - Manson, JoAnn E
AU - Martin, Lisa W
AU - Matsushita, Kunihiro
AU - Meijer, Karina
AU - Overvad, Kim
AU - Prescott, Eva B
AU - Puurunen, Marja K
AU - Rossouw, Jacques
AU - Sang, Yingying
AU - Severinsen, Marianne T
AU - Ten Berg, Jur M
AU - Folsom, Aaron R
AU - Zakai, Neil A
PY - 2017
Y1 - 2017
N2 - BACKGROUND: -There is much controversy surrounding the association of traditional cardiovascular disease (CVD) risk factors with venous thromboembolism (VTE).METHODS: - We performed an individual level random-effect meta-analysis including 9 prospective studies with measured baseline CVD risk factors and validated VTE events. Definitions were harmonized across studies. Traditional CVD risk factors were modeled categorically, as well as continuously using restricted cubic splines. Estimates were obtained for overall VTE, provoked (i.e., VTE occurring in the presence of one or more established VTE risk factors) and unprovoked VTE, pulmonary embolism (PE) and deep-vein thrombosis (DVT).RESULTS: -The studies included 244,865 participants with 4,910 VTE events occurring during a mean follow-up 4.7-19.7 years per study. Age, sex, and body-mass index adjusted hazard ratios for overall VTE were 0.98 (95%CI, 0.89-1.07) for hypertension, 0.97 (0.88-1.08) for hyperlipidemia, 1.01 (0.89-1.15) for diabetes and 1.19 (1.08-1.32) for current smoking. After full adjustment these estimates were numerically similar. When modeled continuously, an inverse association was observed for systolic blood pressure (HR=0.79 [95% CI, 0.68-0.92] at systolic blood pressure 160 vs. 110 mmHg), but not for diastolic blood pressure or lipid measures with VTE. An important finding from VTE subtype analyses was that cigarette smoking was associated with provoked but not with unprovoked VTE. Fully adjusted hazard ratios for the associations of current smoking with provoked and unprovoked VTE were 1.36 (95% CI, 1.22-1.52) and 1.08 (0.90-1.29), respectively.CONCLUSIONS: -Except the association of cigarette smoking with provoked VTE, which is potentially mediated through comorbid conditions such as cancer, the modifiable traditional CVD risk factors are not associated with increased VTE risk. Higher systolic blood pressure showed inverse association with VTE.
AB - BACKGROUND: -There is much controversy surrounding the association of traditional cardiovascular disease (CVD) risk factors with venous thromboembolism (VTE).METHODS: - We performed an individual level random-effect meta-analysis including 9 prospective studies with measured baseline CVD risk factors and validated VTE events. Definitions were harmonized across studies. Traditional CVD risk factors were modeled categorically, as well as continuously using restricted cubic splines. Estimates were obtained for overall VTE, provoked (i.e., VTE occurring in the presence of one or more established VTE risk factors) and unprovoked VTE, pulmonary embolism (PE) and deep-vein thrombosis (DVT).RESULTS: -The studies included 244,865 participants with 4,910 VTE events occurring during a mean follow-up 4.7-19.7 years per study. Age, sex, and body-mass index adjusted hazard ratios for overall VTE were 0.98 (95%CI, 0.89-1.07) for hypertension, 0.97 (0.88-1.08) for hyperlipidemia, 1.01 (0.89-1.15) for diabetes and 1.19 (1.08-1.32) for current smoking. After full adjustment these estimates were numerically similar. When modeled continuously, an inverse association was observed for systolic blood pressure (HR=0.79 [95% CI, 0.68-0.92] at systolic blood pressure 160 vs. 110 mmHg), but not for diastolic blood pressure or lipid measures with VTE. An important finding from VTE subtype analyses was that cigarette smoking was associated with provoked but not with unprovoked VTE. Fully adjusted hazard ratios for the associations of current smoking with provoked and unprovoked VTE were 1.36 (95% CI, 1.22-1.52) and 1.08 (0.90-1.29), respectively.CONCLUSIONS: -Except the association of cigarette smoking with provoked VTE, which is potentially mediated through comorbid conditions such as cancer, the modifiable traditional CVD risk factors are not associated with increased VTE risk. Higher systolic blood pressure showed inverse association with VTE.
U2 - 10.1161/CIRCULATIONAHA.116.024507
DO - 10.1161/CIRCULATIONAHA.116.024507
M3 - Journal article
C2 - 27831499
SN - 0009-7322
VL - 135
SP - 7
EP - 16
JO - Circulation
JF - Circulation
IS - 1
ER -