Association Between Cardiovascular Disease Risk Factors and Occurrence of Venous Thromboembolism: A Time-Dependent Analysis

Wattanakit, Keattiyoat; Lutsey, Pamela L; Bell, Elizabeth J.; Gornik, Heather L.; Cushman, Mary; Heckbert, Susan R.; Rosamond, Wayne D.; Folsom, Aaron R.; Midwest, HeartCare

doi:10.1016/s0735-1097(12)61612-x

Cited by 63 publications

(110 citation statements)

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“…21,22 Moreover, growing evidence supports the concept that traditional atherosclerotic risk factors, including diabetes mellitus, hypertension, and dyslipidemia, are not associated with venous thrombosis. 11,[23][24][25][26] Obesity and advancing age are shared risk factors for arterial and venous thrombosis. However, adjustments for age and BMI in addition to traditional atherosclerotic risk factors only modestly affected the risk estimates in the present study, which indicates that these 2 common factors could not fully explain the observed association between VTE and risk of future MI.…”

Section: Discussionmentioning

confidence: 99%

Impact of Incident Venous Thromboembolism on Risk of Arterial Thrombotic Diseases

et al. 2014

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Background-Growing evidence supports an association between venous thromboembolism (VTE) and arterial thrombotic diseases (ie, myocardial infarction and ischemic stroke). We aimed to study the association between VTE and future arterial events and to determine the population attributable risk of arterial events by VTE in a large prospective cohort recruited from the general population. Methods and Results-In 1994 to 1995 and 1993 to 1997, 81 687 subjects were included in the Tromsø Study and in the Diet, Cancer and Health Study and followed up to the date of incident venous and arterial events (myocardial infarction or ischemic stroke), death or migration, or to the end of the study period (2010 and 2008, respectively). There were 1208 cases of VTE and 90 subsequent arterial events during a median follow-up of 12.2 years. An association between VTE and future arterial events was found in all women and men aged <65 years but not in men aged >65 years. Women <65 years old with VTE had 3.3-fold higher risk of arterial disease (adjusted hazard ratio, 3.28; 95% confidence interval, 1.69-6.35) compared with women of the same age without VTE. The corresponding hazard ratio in men aged <65 years was 2.06 (95% confidence interval, 1.32-3.20). Only 0.9% of the arterial events were attributed to VTE, and the VTE explained 63.8% of the risk of arterial events among VTE patients. Conclusions-Our findings imply that women and young men with VTE have higher risk of arterial thrombotic disease than those without VTE. However, only 1% of the arterial thrombotic events in the population are attributed to VTE. (Circulation. 2014;129:855-863.)

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Section: Discussionmentioning

confidence: 99%

Impact of Incident Venous Thromboembolism on Risk of Arterial Thrombotic Diseases

et al. 2014

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“…[10][11][12][13][14][15][16][17][18] However, growing evidence supports the notion that atherosclerotic risk factors, including diabetes mellitus, hypertension, and dyslipidemia, are not associated with VTE. [19][20][21][22][23] Obesity and advancing age were the only shared risk factors for arterial and venous thrombosis in cohort studies, investigating the influence of atherosclerotic risk factors on risk of MI and VTE within the same population. 19,20 The effect of atherosclerotic risk factors on the association between FHMI and risk of VTE remains unsettled.…”

Section: Clinical Perspective On P 691mentioning

confidence: 99%

Family History of Myocardial Infarction and Cause-Specific Risk of Myocardial Infarction and Venous Thromboembolism

Lind

Enga

Mathiesen

et al. 2014

Circ Cardiovasc Genet

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Background-A family history of myocardial infarction (FHMI) has been shown to increase the risk of venous thromboembolism (VTE). The mechanism underlying the association remains unclear. Therefore, we aimed to determine the risks of MI and VTE by FHMI using a cause-specific model and to explore whether atherosclerotic risk factors could explain the association between FHMI and VTE in a population-based cohort.

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“…Unfortunately, repeat measurements on atherosclerotic risk factors were not available for all participants in our study, and as discussed in our article, residual confounding by modifiable risk factors cannot be completely ruled out. However, because most large cohort studies, including the Tromsø study, 2 found no association between atherosclerotic risk factors and VTE, [3][4][5] we do not think it is likely that the degree of confounder misclassification during follow-up would be different among those who did and did not develop VTE.…”

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confidence: 82%

Response to Letter Regarding Article, “Impact of Incident Venous Thromboembolism on Risk of Arterial Thrombotic Diseases”

et al. 2014

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We thank Dr Chaix and colleagues for their interest in our publication. 1 In their letter to the editor, they question whether the higher prevalence of important atherosclerotic risk factors in those with venous thromboembolism (VTE) who subsequently developed arterial thrombotic disease (ATD) compared with the VTE-only group could be partially responsible for the ATD. First, we want to remind the readers that the aim of the present study was to investigate whether subjects with VTE had higher risk of ATD compared with those without VTE. Thus, with regard to confounding, the interrogating question would be whether a higher prevalence of atherosclerotic risk factors in the VTE group overall compared with those without VTE could explain the higher risk of ATD. To assess the impact of potential confounders on the association between VTE and ATD, we applied a multivariable Cox regression model that included traditional atherosclerotic risk factors, and the results were presented in Table 3 in the article. Adjustments for body mass index, diabetes mellitus, hypertension, hypercholesterolemia, smoking, physical activity, and education level had a slight impact on the risk estimate (17% change) in that it changed from 1.42 (95% confidence interval, 1.15-1.75) in the age-and sex-adjusted model to 1.35 (95% confidence interval, 1.09-1.66) in the multivariable model.We completely agree that atherosclerotic risk factors such as diabetes mellitus, hypertension, and hypercholesterolemia are modifiable and that the individual atherosclerotic risk profile consequently may have changed during follow-up (median, 12.2 years) in some subjects in our study population. Unfortunately, repeat measurements on atherosclerotic risk factors were not available for all participants in our study, and as discussed in our article, residual confounding by modifiable risk factors cannot be completely ruled out. However, because most large cohort studies, including the Tromsø study, 2 found no association between atherosclerotic risk factors and VTE, 3-5 we do not think it is likely that the degree of confounder misclassification during follow-up would be different among those who did and did not develop VTE. DisclosuresNone. Caroline Lind, BSc

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Association Between Cardiovascular Disease Risk Factors and Occurrence of Venous Thromboembolism: A Time-Dependent Analysis

Cited by 63 publications

References 0 publications

Impact of Incident Venous Thromboembolism on Risk of Arterial Thrombotic Diseases

Impact of Incident Venous Thromboembolism on Risk of Arterial Thrombotic Diseases

Family History of Myocardial Infarction and Cause-Specific Risk of Myocardial Infarction and Venous Thromboembolism

Response to Letter Regarding Article, “Impact of Incident Venous Thromboembolism on Risk of Arterial Thrombotic Diseases”

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