Cardiovascular Risk Factors Associated With Venous Thromboembolism

Gregson, John; Kaptoge, Stephen; Bolton, Thomas; Pennells, Lisa; Willeit, Peter; Burgess, Stephen; Bell, Steven; Sweeting, Michael; Rimm, Eric B.; Kabrhel, Christopher; Zöller, Bengt; Assmann, Gerd; Gudnason, Vilmundur; Folsom, Aaron R.; Arndt, Volker; Fletcher, Astrid; Norman, Paul; Nordestgaard, Børge G.; Kitamura, Akihiko; Mahmoodi, Bakhtawar K.; Whincup, Peter H.; Knuiman, Matthew; Salomaa, Veikko; Meisinger, Christa; Köenig, Wolfgang; Kavousi, Maryam; Völzke, Henry; Cooper, Jackie A.; Ninomiya, Toshiharu; Casíglia, Edoardo; Rodríguez, Beatriz L.; Ben-Shlomo, Yoav; Després, Jean‐Pierre; Simons, Leon A.; Barrett‐Connor, Elizabeth; Björkelund, Cecilia; Notdurfter, Marlene; Kromhout, Daan; Price, Jackie F.; Sutherland, Susan E.; Sundström, Johan; Kauhanen, Jussi; Gallacher, John; Beulens, Joline; Dankner, Rachel; Cooper, Cyrus; Giampaoli, Simona; Deen, Jason F.; Cámara, Agustı́n Gómez de la; Kuller, Lewis H.; Rosengren, Annika; Svensson, Peter; Nagel, Dorothea; Crespo, Carlos; Brenner, Hermann; Albertorio-Díaz, Juan R.; Atkins, Robert C.; Brunner, Eric J.; Shipley, Martin J.; Njølstad, Inger; Lawlor, Deborah A; Schouw, Yvonne T. van der; Selmer, Randi; Trevisan, Maurizio; Verschuren, W M Monique; Greenland, Philip; Wassertheil‐Smoller, Sylvia; Lowe, G. D. O.; Wood, Angela; Butterworth, Adam S.; Thompson, Simon G.; Danesh, John; Angelantonio, Emanuele Di; Meade, T W

doi:10.1001/jamacardio.2018.4537

Cited by 249 publications

(217 citation statements)

References 51 publications

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“…Compared with the results of previous reports on adult cohorts, our findings show a higher risk increase in obese individuals [5,10,14,15,30]. There are several potential explanations for this.…”

Section: Discussioncontrasting

confidence: 72%

“…The median follow-up time was 28 years for the entire group (interquartile range, 20-36 years). 28 [20,36] 31 [22,40] 30 [22,39] 28 [20,37] 26 [19,35] 25 [16,33] 24 [16,32] 22 [15,30] 19 [13,27] Age, years (SD) 18…”

Section: Study Populationmentioning

confidence: 99%

“…The global burden of obesity (BMI ≥ 30 kg m À2 ) is increasing, particularly of severe obesity (BMI ≥ 35 kg m À2 ), where 2.3% of the men and 5.0% of the women were estimated to be severely obese in 2014 [1]. The global prevalence of obesity in children aged [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] years increased between 1975 and 2016, reaching 5.6% in girls and 7.8% in boys, with a childhood obesity prevalence of over 20% in many countries [2]. Obesity is an important contributor to morbidity and mortality in cardiovascular disease, type 2 diabetes and cancer [3].…”

Section: Introductionmentioning

confidence: 99%

“…In contrast, a large Danish Mendelian randomization study of middle-aged individuals followed for up to 35 years showed high hazard ratios (HR) of 5.1 for DVT complicated by PE for severely obese individuals (BMI ≥ 35 kg m À2 ) compared to normal weight; however, patients with pulmonary embolism (PE) without a documented deep vein thrombosis (DVT) were excluded [11]. Other, more recent, studies in middle-aged persons have also shown a relationship between obesity and VTE [12][13][14][15]. So far, there have been no studies investigating the effect of severe obesity in late adolescence on subsequent VTE risk, which is important, given that this is a rapidly growing segment of the population, affecting large groups of young men and women.…”

Section: Introductionmentioning

confidence: 99%

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Obesity in adolescent men increases the risk of venous thromboembolism in adult life

et al. 2020

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Obesity in adolescent men increases the risk of venous thromboembolism in adult life. J Intern Med 2020; 287: 734-745.Background. As the population of obese and severely obese young adults grows, it is becoming increasingly important to recognize the long-term risks associated with adolescent obesity.Objectives. This study aimed to determine the association between body mass index (BMI) in young men at enlistment for military service and later risk of venous thromboembolism (VTE).Methods. Nationwide register-based prospective cohort study of men enlisting 1969 to 2005, followed through the Swedish National Patient and Cause of Death registries. We identified 1 639 838 men (mean age, 18.3 years) free of prior venous thromboembolism, of whom 29 342 were obese (BMI 30 to <35 kg m À2 ) and 7236 severely obese (BMI ≥ 35 kg m À2 ). The participants were followed until a first registered diagnosis of VTE.Results. During a median follow-up of 28 years (interquartile interval, 20 to 36 years), 11 395 cases of deep vein thrombosis and 7270 cases of pulmonary embolism were recorded. Compared with men with a BMI of 18.5 to <20 kg m À2 , men with higher BMI in young adulthood showed an incrementally increasing risk of VTE that was moderately but significantly increased already at normal BMI levels. Adolescent obese men with a BMI of 30 to 35 kg m À2 had an adjusted hazard ratio of 2.93 (95% confidence interval, 2.65 to 3.24) for VTE. Severely obese men with a BMI of ≥35 kg m À2 had a hazard ratio of 4.95 (95% confidence interval, 4.16 to 5.90).Conclusions. Men who were obese or severely obese in young adulthood had a marked increase in risk of VTE.

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Section: Discussioncontrasting

confidence: 72%

Section: Study Populationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Obesity in adolescent men increases the risk of venous thromboembolism in adult life

et al. 2020

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“…Venous thromboembolism (VTE) [comprising deep vein thrombosis (DVT) and pulmonary embolism (PE)], is closely linked with arterial thrombotic disease [11][12][13], and represents a growing public health burden due to increased morbidity, premature mortality, hospitalization, and associated healthcare costs [14][15][16][17]. The literature suggests both conditions may share some common risk factors such as obesity and cigarette smoking [18][19][20]. Factors implicated in the pathogenesis of VTE include inflammation, endothelial dysfunction, alterations in blood flow, immobilization, and hypercoagulable states [21][22][23] and physical activity is known to exert beneficial effects on some of these states [7,24,25].…”

Section: Introductionmentioning

confidence: 99%

Physical activity and risk of venous thromboembolism: systematic review and meta-analysis of prospective cohort studies

et al. 2019

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The inverse association between physical activity and arterial thrombotic disease is well established. Evidence on the association between physical activity and venous thromboembolism (VTE) is divergent. We conducted a systematic review and meta-analysis of published observational prospective cohort studies evaluating the associations of physical activity with VTE risk. MEDLINE, Embase, Web of Science, and manual search of relevant bibliographies were systematically searched until 26 February 2019. Extracted relative risks (RRs) with 95% confidence intervals (CIs) for the maximum versus minimal amount of physical activity groups were pooled using random effects meta-analysis. Twelve articles based on 14 unique prospective cohort studies comprising of 1,286,295 participants and 23,753 VTE events were eligible. The pooled fully-adjusted RR (95% CI) of VTE comparing the most physically active versus the least physically active groups was 0.87 (0.79-0.95). In pooled analysis of 10 studies (288,043 participants and 7069 VTE events) that reported risk estimates not adjusted for body mass index (BMI), the RR (95% CI) of VTE was 0.81 (0.70-0.93). The associations did not vary by geographical location, age, sex, BMI, and methodological quality of studies. There was no evidence of publication bias among contributing studies. Pooled observational prospective cohort studies support an association between regular physical activity and low incidence of VTE. The relationship does not appear to be mediated or confounded by BMI.stimulate further efforts to further clarify the relationship between physical activity and VTE risk.

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Diagnosis and Treatment of Lower Extremity Venous Thromboembolism

Chopard

Albertsen

Piazza

2020

JAMA

126

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ower extremity venous thromboembolism (VTE), including deep vein thrombosis (DVT) of the leg, is common. 1 The incidence rate for DVT ranges from 88 to 112 per 100 000 person-years. 2 Rates of recurrent VTE range from 20% to 36% during the 10 years after an initial event. 3,4 Isolated distal DVT, defined as thrombosis involving 1 or more of the deep calf veins without reaching the popliteal vein, is associated with a 1-year all-cause mortality rate of 4.6 per 100 person-years (95% CI, 3.8-5.7). 5 This review provides an evidence-based update of the diagnosis and therapy of lower extremity DVT. MethodsWe searched PubMed and the Cochrane databases for Englishlanguage studies published from January 2015 through June 2020 for randomized clinical trials, meta-analyses, systematic reviews, and observational studies, resulting in 2125 retrieved articles (see eAppendix in the Supplement for search terms). We manually searched references of selected articles, reviews, meta-analyses, and practice guidelines. Selected articles were mutually agreed on by the authors. A total of 86 articles (20 randomized clinical trials, 20 systematic reviews and meta-analyses, 33 observational cohort studies, 7 reviews, and 6 guideline documents) were included in the final review. Randomized clinical trials and meta-analyses and information of interest to a general medical readership were prioritized. Risk Factors for VTEMost patients with VTE have multiple risk factors for VTE (Table 1). Risk factors include demographic factors (eg, older age, IMPORTANCE Incidence rates for lower extremity deep vein thrombosis (DVT) range from 88 to 112 per 100 000 person-years and increase with age. Rates of recurrent VTE range from 20% to 36% during the 10 years after an initial event.OBSERVATIONS PubMed and Cochrane databases were searched for English-language studies published from January 2015 through June 2020 for randomized clinical trials, meta-analyses, systematic reviews, and observational studies. Risk factors for venous thromboembolism (VTE), such as older age, malignancy (cumulative incidence of 7.4% after a median of 19 months), inflammatory disorders (VTE risk is 4.7% in patients with rheumatoid arthritis and 2.5% in those without), and inherited thrombophilia (factor V Leiden carriers with a 10-year cumulative incidence of 10.9%), are associated with higher risk of VTE. Patients with signs or symptoms of lower extremity DVT, such as swelling (71%) or a cramping or pulling discomfort in the thigh or calf (53%), should undergo assessment of pretest probability followed by D-dimer testing and imaging with venous ultrasonography. A normal D-dimer level (ie, D-dimer <500 ng/mL) excludes acute VTE when combined with a low pretest probability (ie, Wells DVT score Յ1). In patients with a high pretest probability, the negative predictive value of a D-dimer less than 500 ng/mL is 92%. Consequently, D-dimer cannot be used to exclude DVT without an assessment of pretest probability. Postthrombotic syndrome, defined as persistent symptoms, signs of ch...

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Cardiovascular Risk Factors Associated With Venous Thromboembolism

Cited by 249 publications

References 51 publications

Obesity in adolescent men increases the risk of venous thromboembolism in adult life

Obesity in adolescent men increases the risk of venous thromboembolism in adult life

Physical activity and risk of venous thromboembolism: systematic review and meta-analysis of prospective cohort studies

Diagnosis and Treatment of Lower Extremity Venous Thromboembolism

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