Risk Factors of Cardiovascular Death after Venous Thromboembolism: Results from a Prospective Cohort Study

Abstract

Background Cardiovascular deaths (CVDTs) are more frequent in patients with venous thromboembolism (VTE) than in the general population; however, risk factors associated with this increased risk of CVDT in patients with VTE are not described.

Methods To determine the risk factors of CVDT in patients with VTE from a multicenter prospective cohort study, Fine and Gray subdistribution hazard models were conducted.

Results Of the 3,988 included patients, 426 (10.7%) died of CVDT during a median follow-up of 5 years. The risk factors of CVDT after multivariate analyses were: age of 50 to 65 years (vs. <50 years, hazard ratio [HR]: 3.22, 95% confidence interval [CI]: 1.67–6.62), age >65 years (vs. <50 years, HR: 7.60, 95% CI: 3.73–15.52), cancer-associated VTE (vs. transient risk factor-related VTE, HR: 1.73, 95% CI: 1.15–2.61), unprovoked VTE (vs. transient risk factor-related VTE, HR: 1.42, 95% CI: 1.02–2.00), past tobacco use (vs. never, HR: 1.43, 95% CI: 1.06–1.94), current tobacco use (vs. never, HR: 1.87, 95% CI: 1.15–3.01), hypertension (HR: 2.11, 95% CI: 1.51–2.96), chronic heart failure (HR: 2.28, 95% CI: 1.37–3.79), chronic respiratory failure (HR: 1.72, 95% CI: 1.02–2.89), and atrial fibrillation (HR: 1.67, 95% CI: 1.06–2.60). The risk of CVDT was significantly reduced with direct oral anticoagulants (vs. vitamin-K antagonists) and with longer duration of treatment (>3 months).

Conclusion Risk factors of CVDT after VTE include some traditional cardiovascular risk factors and other risk factors that are related to characteristics of VTE, and patients' comorbidities.

Keywords

venous thromboembolism - cardiovascular deaths - cardiovascular mortality - risk factors - predictor - prospective cohort

Ethical Approval and Consent to Participate

The study was approved by the Ethics Committee of Brest University Teaching Hospital (CCP-Ouest 6–390) with a last amendment approved on November 20, 2013 under reference number: EDITH II/RB 05.003. Administrative approvals were also obtained from authorities of the Brest University Teaching Hospital and all other recruiting centers. All participants singed a consent form.

Availability of Data and Materials

The data that support the findings of this study are available from S.R.N. or F.C., upon reasonable request.

Author Contributions

Conception and design: S.R.N., F.C., L.B., R.D.; acquisition of data: E.P.; data analysis: S.R.N.; analysis and interpretation of data: S.R.N., F.C., L.B.; manuscript drafting: S.R.N.; manuscript revision: all authors; approved the final version of the manuscript: all authors; obtaining funding: F.C.; administrative, technical, and material support: F.C., C.T., R.D.; study supervision: F.C.; full access to all the data of the study: F.C., S.R.N.; responsibility for all aspect of the study, reliability, and freedom from bias of the data presented: all authors.

Publikationsverlauf

Eingereicht: 23. Dezember 2021

Angenommen: 13. März 2022

Artikel online veröffentlicht:
18. Juni 2022

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