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Cardiovascular Risk Factors Associated With Venous Thromboembolism.

TitleCardiovascular Risk Factors Associated With Venous Thromboembolism.
Publication TypeJournal Article
Year of Publication2019
AuthorsGregson J, Kaptoge S, Bolton T, Pennells L, Willeit P, Burgess S, Bell S, Sweeting M, Rimm EB, Kabrhel C, Zöller B, Assmann G, Gudnason V, Folsom AR, Arndt V, Fletcher A, Norman PE, Nordestgaard BG, Kitamura A, Mahmoodi BK, Whincup PH, Knuiman M, Salomaa V, Meisinger C, Koenig W, Kavousi M, Völzke H, Cooper JA, Ninomiya T, Casiglia E, Rodriguez B, Ben-Shlomo Y, Després J-P, Simons L, Barrett-Connor E, Björkelund C, Notdurfter M, Kromhout D, Price J, Sutherland SE, Sundström J, Kauhanen J, Gallacher J, Beulens JWJ, Dankner R, Cooper C, Giampaoli S, Deen JF, de la Cámara AGómez, Kuller LH, Rosengren A, Svensson PJ, Nagel D, Crespo CJ, Brenner H, Albertorio-Diaz JR, Atkins R, Brunner EJ, Shipley M, Njølstad I, Lawlor DA, van der Schouw YT, Selmer RMarie, Trevisan M, Verschuren WMMonique, Greenland P, Wassertheil-Smoller S, Lowe GDO, Wood AM, Butterworth AS, Thompson SG, Danesh J, Di Angelantonio E
Secondary AuthorsMeade T
Corporate AuthorsEmerging Risk Factors Collaboration
JournalJAMA Cardiol
Volume4
Issue2
Pagination163-173
Date Published2019 02 01
ISSN2380-6591
KeywordsAdult, Body Mass Index, Cardiovascular Diseases, Coronary Disease, Diabetes Mellitus, Female, Humans, Male, Middle Aged, Obesity, Outcome Assessment, Health Care, Prospective Studies, Pulmonary Embolism, Risk Factors, Smoking, United Kingdom, Venous Thromboembolism, Venous Thrombosis
Abstract

Importance: It is uncertain to what extent established cardiovascular risk factors are associated with venous thromboembolism (VTE).

Objective: To estimate the associations of major cardiovascular risk factors with VTE, ie, deep vein thrombosis and pulmonary embolism.

Design, Setting, and Participants: This study included individual participant data mostly from essentially population-based cohort studies from the Emerging Risk Factors Collaboration (ERFC; 731 728 participants; 75 cohorts; years of baseline surveys, February 1960 to June 2008; latest date of follow-up, December 2015) and the UK Biobank (421 537 participants; years of baseline surveys, March 2006 to September 2010; latest date of follow-up, February 2016). Participants without cardiovascular disease at baseline were included. Data were analyzed from June 2017 to September 2018.

Exposures: A panel of several established cardiovascular risk factors.

Main Outcomes and Measures: Hazard ratios (HRs) per 1-SD higher usual risk factor levels (or presence/absence). Incident fatal outcomes in ERFC (VTE, 1041; coronary heart disease [CHD], 25 131) and incident fatal/nonfatal outcomes in UK Biobank (VTE, 2321; CHD, 3385). Hazard ratios were adjusted for age, sex, smoking status, diabetes, and body mass index (BMI).

Results: Of the 731 728 participants from the ERFC, 403 396 (55.1%) were female, and the mean (SD) age at the time of the survey was 51.9 (9.0) years; of the 421 537 participants from the UK Biobank, 233 699 (55.4%) were female, and the mean (SD) age at the time of the survey was 56.4 (8.1) years. Risk factors for VTE included older age (ERFC: HR per decade, 2.67; 95% CI, 2.45-2.91; UK Biobank: HR, 1.81; 95% CI, 1.71-1.92), current smoking (ERFC: HR, 1.38; 95% CI, 1.20-1.58; UK Biobank: HR, 1.23; 95% CI, 1.08-1.40), and BMI (ERFC: HR per 1-SD higher BMI, 1.43; 95% CI, 1.35-1.50; UK Biobank: HR, 1.37; 95% CI, 1.32-1.41). For these factors, there were similar HRs for pulmonary embolism and deep vein thrombosis in UK Biobank (except adiposity was more strongly associated with pulmonary embolism) and similar HRs for unprovoked vs provoked VTE. Apart from adiposity, these risk factors were less strongly associated with VTE than CHD. There were inconsistent associations of VTEs with diabetes and blood pressure across ERFC and UK Biobank, and there was limited ability to study lipid and inflammation markers.

Conclusions and Relevance: Older age, smoking, and adiposity were consistently associated with higher VTE risk.

DOI10.1001/jamacardio.2018.4537
Alternate JournalJAMA Cardiol
PubMed ID30649175
PubMed Central IDPMC6386140
Grant ListRG/13/13/30194 / BHF_ / British Heart Foundation / United Kingdom
MC_U147585827 / MRC_ / Medical Research Council / United Kingdom
MC_QA137853 / MRC_ / Medical Research Council / United Kingdom
MC_UU_12011/2 / MRC_ / Medical Research Council / United Kingdom
MC_U147585819 / MRC_ / Medical Research Council / United Kingdom
19583 / VAC_ / Versus Arthritis / United Kingdom
G0400491 / MRC_ / Medical Research Council / United Kingdom
RG/18/13/33946 / BHF_ / British Heart Foundation / United Kingdom
MR/R024227/1 / MRC_ / Medical Research Council / United Kingdom
MC_UP_A620_1015 / MRC_ / Medical Research Council / United Kingdom
MC_UP_A620_1014 / MRC_ / Medical Research Council / United Kingdom
MC_UU_00002/7 / MRC_ / Medical Research Council / United Kingdom
RG/16/11/32334 / BHF_ / British Heart Foundation / United Kingdom
10/33/04 / DH_ / Department of Health / United Kingdom
MR/K013351/1 / MRC_ / Medical Research Council / United Kingdom
MC_UU_12011/1 / MRC_ / Medical Research Council / United Kingdom
MC_PC_17228 / MRC_ / Medical Research Council / United Kingdom
RG/13/16/30528 / BHF_ / British Heart Foundation / United Kingdom
G0601019 / MRC_ / Medical Research Council / United Kingdom
MC_UU_12013/5 / MRC_ / Medical Research Council / United Kingdom
MC_U147585824 / MRC_ / Medical Research Council / United Kingdom