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Association of Traditional Cardiovascular Risk Factors With Venous Thromboembolism: An Individual Participant Data Meta-Analysis of Prospective Studies.

TitleAssociation of Traditional Cardiovascular Risk Factors With Venous Thromboembolism: An Individual Participant Data Meta-Analysis of Prospective Studies.
Publication TypeJournal Article
Year of Publication2017
AuthorsMahmoodi BK, Cushman M, Næss IAnne, Allison MA, Bos WJ, Brækkan SK, Cannegieter SC, Gansevoort RT, Gona PN, Hammerstrøm J, Hansen J-B, Heckbert S, Holst AG, Lakoski SG, Lutsey PL, Manson JAE, Martin LW, Matsushita K, Meijer K, Overvad K, Prescott E, Puurunen M, Rossouw JE, Sang Y, Severinsen MT, Berg JTen, Folsom AR
Secondary AuthorsZakai NA
JournalCirculation
Volume135
Issue1
Pagination7-16
Date Published2017 01 03
ISSN1524-4539
KeywordsAge Factors, Blood Pressure, Body Mass Index, Diabetes Complications, Humans, Hyperlipidemias, Hypertension, Lipids, Proportional Hazards Models, Prospective Studies, Pulmonary Embolism, Risk Factors, Sex Factors, Smoking, Venous Thromboembolism, Venous Thrombosis
Abstract

BACKGROUND: Much controversy surrounds the association of traditional cardiovascular disease risk factors with venous thromboembolism (VTE).

METHODS: We performed an individual level random-effect meta-analysis including 9 prospective studies with measured baseline cardiovascular disease risk factors and validated VTE events. Definitions were harmonized across studies. Traditional cardiovascular disease risk factors were modeled categorically and continuously using restricted cubic splines. Estimates were obtained for overall VTE, provoked VTE (ie, VTE occurring in the presence of 1 or more established VTE risk factors), and unprovoked VTE, pulmonary embolism, and deep-vein thrombosis.

RESULTS: The studies included 244 865 participants with 4910 VTE events occurring during a mean follow-up of 4.7 to 19.7 years per study. Age, sex, and body mass index-adjusted hazard ratios for overall VTE were 0.98 (95% confidence interval [CI]: 0.89-1.07) for hypertension, 0.97 (95% CI: 0.88-1.08) for hyperlipidemia, 1.01 (95% CI: 0.89-1.15) for diabetes mellitus, and 1.19 (95% CI: 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 (hazard ratio=0.79 [95% CI: 0.68-0.92] at systolic blood pressure 160 vs 110 mm Hg) 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 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 (95% CI: 0.90-1.29), respectively.

CONCLUSIONS: Except for the association between cigarette smoking and provoked VTE, which is potentially mediated through comorbid conditions such as cancer, the modifiable traditional cardiovascular disease risk factors are not associated with increased VTE risk. Higher systolic blood pressure showed an inverse association with VTE.

DOI10.1161/CIRCULATIONAHA.116.024507
Alternate JournalCirculation
PubMed ID27831499
PubMed Central IDPMC5201424
Grant ListN01WH32109 / WH / WHI NIH HHS / United States
HHSN268201100008C / HL / NHLBI NIH HHS / United States
N01 WH032109 / WH / WHI NIH HHS / United States
R01 HL059367 / HL / NHLBI NIH HHS / United States
R01 HL083926 / HL / NHLBI NIH HHS / United States
HHSN268201500001I / HL / NHLBI NIH HHS / United States
R01 HL126538 / HL / NHLBI NIH HHS / United States
Z99 HL999999 / / Intramural NIH HHS / United States
RC1 HL099460 / HL / NHLBI NIH HHS / United States
N01WH42108 / WH / WHI NIH HHS / United States