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Thromb Haemost 2012; 108(03): 508-515
DOI: 10.1160/TH11-10-0726
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Association between cardiovascular disease risk factors and occurrence of venous thromboembolism

A time-dependent analysis
Keattiyoat Wattanakit
1   Cardiology, HeartCare Midwest, Peoria, Illinois, USA
,
Pamela L. Lutsey
2   Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
,
Elizabeth J. Bell
2   Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
,
Heather Gornik
3   Vascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
,
Mary Cushman
4   Department of Medicine, University of Vermont, Colchester, Vermont, USA
,
Susan R. Heckbert
5   Epidemiology, University of Washington, Seattle, Washington, USA
,
Wayne D. Rosamond
6   Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
,
Aaron R. Folsom
2   Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
› Author Affiliations
Further Information

Publication History

Received: 23 October 2011

Accepted after major revision: 19 May 2012

Publication Date:
25 November 2017 (online)

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Summary

Apart from obesity, it remains controversial whether atherosclerosis and its cardiovascular risk disease (CVD) factors are associated with risk of venous thromboembolism (VTE). Using data from the Atherosclerosis Risk in Communities study (ARIC), we evaluated associations between CVD risk factors and incident VTE in a cohort of 15,340 participants who were free a history of VTE and/or anticoagulant use on enrolment. The CVD risk factors were updated during the follow-up period. Over a mean follow-up time of 15.5 years (237,375 person-years), 468 participants had VTE events. Adjusting for demographic variables and body mass index (BMI), current smokers were at greater risk [HR of 1.44 (95% CI: 1.12–1.86)] compared to non-smokers. There was a positive monotonic association between BMI and VTE risk. Individuals with a BMI ≥35 kg/m2 had a HR for VTE of 3.09 (95%CI: 2.26–4.23) compared to those with normal BMI (<25 kg/m2). Greater physical activity was associated with lower VTE risk in a demographic adjusted model; however, this association became non-significant following adjustment for BMI. Alcohol intake, diabetes, hypertension, high-density lipoprotein and low-density lipoprotein cholesterol, and triglycerides were not associated with VTE risk. In conclusion, among the well-established CVD risk factors, only current smoking and obesity were independently associated with VTE risk in this large cohort where risk factors were updated serially during follow-up. This finding corroborates that the pathogenesis of venous disease differs from that of atherosclerotic disease.

Keywords

Deep-vein thrombosis - pulmonary embolism - risk factors
 

  • References

  • 1 Prandoni P, Bilora F, Marchiori A. et al. An association between atherosclerosis and venous thrombosis. N Engl J Med 2003; 348: 1435-1441.
    CrossrefPubMedGoogle Scholar
  • 2 Hong C, Zhu F, Du D. et al. Coronary artery calcification and risk factors for atherosclerosis in patients with venous thromboembolism. Atherosclerosis 2005; 183: 169-174.
    CrossrefPubMedGoogle Scholar
  • 3 van der Hagen PB, Folsom AR, Jenny NS. et al. Subclinical atherosclerosis and the risk of future venous thrombosis in the Cardiovascular Health Study. J Thromb Haemost 2006; 04: 1903-1908.
    CrossrefPubMedGoogle Scholar
  • 4 Reich LM, Folsom AR, Key NS. et al. Prospective study of subclinical atherosclerosis as a risk factor for venous thromboembolism. J Thromb Haemost 2006; 04: 1909-1913.
    CrossrefPubMedGoogle Scholar
  • 5 Tsai AW, Cushman M, Rosamond WD. et al. Cardiovascular risk factors and venous thromboembolism incidence: the longitudinal investigation of thromboembolism etiology. Arch Intern Med 2002; 162: 1182-1189.
    CrossrefPubMedGoogle Scholar
  • 6 Holst AG, Jensen G, Prescott E. Risk factors for venous thromboembolism: results from the Copenhagen City Heart Study. Circulation 2010; 121: 1896-1903.
    CrossrefPubMedGoogle Scholar
  • 7 Lutsey PL, Virnig BA, Durham SB. et al. Correlates and consequences of venous thromboembolism: The Iowa Women's Health Study. Am J Public Health 2010; 100: 1506-1513.
    CrossrefPubMedGoogle Scholar
  • 8 Ageno W, Becattini C, Brighton T, Selby R, Kamphuisen PW. Cardiovascular risk factors and venous thromboembolism: a meta-analysis. Circulation 2008; 117: 93-102.
    CrossrefPubMedGoogle Scholar
  • 9 Mahmoodi BK, Gansevoort RT, Veeger NJ. et al. Microalbuminuria and risk of venous thromboembolism. J Am Med Assoc 2009; 301: 1790-1797.
    CrossrefPubMedGoogle Scholar
  • 10 The ARIC investigators. The Atherosclerosis Risk in Communities (ARIC) Study: design and objectives. Am J Epidemiol. 1989 129. 687-702.
    PubMedGoogle Scholar
  • 11 Baecke JA, Burema J, Frijters JE. A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr 1982; 36: 936-942.
    CrossrefPubMedGoogle Scholar
  • 12 Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of lowdensity lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972; 18: 499-502.
    PubMedGoogle Scholar
  • 13 Cushman M, Tsai AW, White RH. et al. Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology. Am J Med 2004; 117: 19-25.
    CrossrefPubMedGoogle Scholar
  • 14 Tobin MD, Sheehan NA, Scurrah KJ. et al. Adjusting for treatment effects in studies of quantitative traits: antihypertensive therapy and systolic blood pressure. Stat Med 2005; 24: 2911-2935.
    CrossrefPubMedGoogle Scholar
  • 15 Lutsey PLR-TL, Pankow JS, Alonso A. et al. Relation of lipid gene scores to longitudinal trends in lipid levels and incidence of abnormal lipid levels among Caucasians: The Atherosclerosis Risk in Communities (ARIC) study. Circ Cardiovasc Genet 2012; 05: 73-80.
    CrossrefPubMedGoogle Scholar
  • 16 Goldhaber SZ, Grodstein F, Stampfer MJ. et al. A prospective study of risk factors for pulmonary embolism in women. J Am Med Assoc 1997; 277: 642-645.
    CrossrefPubMedGoogle Scholar
  • 17 Severinsen MT, Kristensen SR, Johnsen SP. et al. Smoking and venous thromboembolism: a Danish follow-up study. J Thromb Haemost 2009; 07: 1297-1303.
    CrossrefPubMedGoogle Scholar
  • 18 Hansson PO, Eriksson H, Welin L. et al. Smoking and abdominal obesity: risk factors for venous thromboembolism among middle-aged men: “the study of men born in 1913”. Arch Intern Med 1999; 159: 1886-1890.
    CrossrefPubMedGoogle Scholar
  • 19 Pomp ER, Rosendaal FR, Doggen CJ. Smoking increases the risk of venous thrombosis and acts synergistically with oral contraceptive use. Am J Hematol 2008; 83: 97-102.
    CrossrefPubMedGoogle Scholar
  • 20 Lee KW, Lip GY. Effects of lifestyle on hemostasis, fibrinolysis, and platelet reactivity: a systematic review. Arch Intern Med 2003; 163: 2368-2392.
    CrossrefPubMedGoogle Scholar
  • 21 Goldhaber SZ, Savage DD, Garrison RJ. et al. Risk factors for pulmonary embolism. The Framingham Study. Am J Med 1983; 74: 1023-1028.
    CrossrefPubMedGoogle Scholar
  • 22 Daly E, Vessey MP, Hawkins MM. et al. Risk of venous thromboembolism in users of hormone replacement therapy. Lancet 1996; 348: 977-980.
    CrossrefPubMedGoogle Scholar
  • 23 Samama MM. An epidemiologic study of risk factors for deep vein thrombosis in medical outpatients: the Sirius study. Arch Intern Med 2000; 160: 3415-3420.
    CrossrefPubMedGoogle Scholar
  • 24 Stein PD, Beemath A, Olson RE. Obesity as a risk factor in venous thromboembolism. Am J Med 2005; 118: 978-980.
    CrossrefPubMedGoogle Scholar
  • 25 Severinsen MT, Kristensen SR, Johnsen SP. et al. Anthropometry, body fat, and venous thromboembolism: a Danish follow-up study. Circulation 2009; 120: 1850-1857.
    CrossrefPubMedGoogle Scholar
  • 26 van Stralen KJ, Le Cessie S, Rosendaal FR. et al. Regular sports activities decrease the risk of venous thrombosis. J Thromb Haemost 2007; 05: 2186-2192.
    CrossrefPubMedGoogle Scholar
  • 27 Glynn RJ, Rosner B. Comparison of risk factors for the competing risks of coronary heart disease, stroke, and venous thromboembolism. Am J Epidemiol 2005; 162: 975-982.
    CrossrefPubMedGoogle Scholar
  • 28 van Stralen KJ, Doggen CJ, Lumley T. et al. The relationship between exercise and risk of venous thrombosis in elderly people. J Am Geriatr Soc 2008; 56: 517-522.
    CrossrefPubMedGoogle Scholar
  • 29 Cogo A, Bernardi E, Prandoni P. et al. Acquired risk factors for deep-vein thrombosis in symptomatic outpatients. Arch Intern Med 1994; 154: 164-168.
    CrossrefPubMedGoogle Scholar
  • 30 Ageno W, Prandoni P, Romualdi E. et al. The metabolic syndrome and the risk of venous thrombosis: a case-control study. J Thromb Haemost 2006; 04: 1914-1918.
    CrossrefPubMedGoogle Scholar
  • 31 Heit JA, Leibson CL, Ashrani AA. et al. Is diabetes mellitus an independent risk factor for venous thromboembolism?: a population-based case-control study. Arterioscler Thromb Vasc Biol 2009; 29: 1399-1405.
    CrossrefPubMedGoogle Scholar
  • 32 Chamberlain AM, Folsom AR, Heckbert SR. et al. High-density lipoprotein cholesterol and venous thromboembolism in the Longitudinal Investigation of Thromboembolism Etiology (LITE). Blood 2008; 112: 2675-2680.
    CrossrefPubMedGoogle Scholar
  • 33 Deguchi H, Pecheniuk NM, Elias DJ. et al. High-density lipoprotein deficiency and dyslipoproteinemia associated with venous thrombosis in men. Circulation 2005; 112: 893-899.
    CrossrefPubMedGoogle Scholar
  • 34 Glynn RJ, Danielson E, Fonseca FA. et al. A randomized trial of rosuvastatin in the prevention of venous thromboembolism. N Engl J Med 2009; 360: 1851-1861.
    CrossrefPubMedGoogle Scholar
  • 35 Grady D, Wenger NK, Herrington D. et al. Postmenopausal hormone therapy increases risk for venous thromboembolic disease. The Heart and Estrogen/progestin Replacement Study. Ann Intern Med 2000; 132: 689-696.
    PubMedGoogle Scholar
  • 36 Undas A, Brummel-Ziedins KE, Mann KG. Statins and blood coagulation. Arterioscler Thromb Vasc Biol 2005; 25: 287-294.
    PubMedGoogle Scholar