Pulmonary Thromboembolism in American Indians and Alaskan Natives

Stein, Paul D.; Kayali, Fadi; Olson, R. E.; Milford, Creagh E.

doi:10.1001/archinte.164.16.1804

Cited by 32 publications

(24 citation statements)

References 13 publications

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“…In the past, venous thromboembolism was thought to be rare in Asia as compared to in Western countries, 1 although according to recent studies, this is not true. [2][3][4][5][6] It is, however, becoming increasingly clear that there are differences in risk factors for thrombosis between Eastern and Western countries.…”

Section: Introductionmentioning

confidence: 99%

Normal ranges and genetic variants of antithrombin, protein C and protein S in the general Chinese population. Results of the Chinese Hemostasis Investigation on Natural Anticoagulants Study I Group

Zhu¹,

Ding²,

Bai³

et al. 2011

Haematologica

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The online version of this article has a Supplementary Appendix. BackgroundInherited deficiency of antithrombin, protein C and protein S, three important, naturally occurring coagulation inhibitors, might play a major role in the occurrence of venous thromboembolism in Chinese. The establishment of age-and gender-related normal ranges of these inhibitors is crucial for an accurate diagnosis of these deficiencies. Design and MethodsWe designed a prospective cross-sectional study recruiting healthy adults from four universityaffiliated hospitals in China. Antithrombin, protein C and protein S were studied by measuring their activity. Gene analysis was performed when natural anticoagulant deficiency was suspected. Polymorphisms of the factor V gene were searched for among subjects who were positive for activated protein C resistance. ResultsIn 3493 healthy Chinese adults (1734 men, 1759 women; age 17-83 years), we found higher age-adjusted activities for protein C and protein S in men than in women but no sex difference for antithrombin. In women, mean protein C and protein S activities increased with age. In men, mean protein C levels increased with age up to the age of 49 but decreased after 50 years old; mean protein S levels decreased after 50 years of age. Antithrombin levels remained stable over time in women but decreased significantly after 50 years of age in men. Reference values according to age and sex allowed the identification of 15 genetic variants (protein C: 10, antithrombin: 3, protein S: 2) in subjects with protein activity below the 1 st percentile. ConclusionsThis is the largest survey ever conducted in the healthy general Chinese population. These normal ranges provide the essential basis for the diagnosis and treatment of thrombosis in Chinese.Key words: antithrombin, protein C, protein S, normal ranges, genetics, Chinese. Citation: Zhu T, Ding

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Section: Introductionmentioning

confidence: 99%

Normal ranges and genetic variants of antithrombin, protein C and protein S in the general Chinese population. Results of the Chinese Hemostasis Investigation on Natural Anticoagulants Study I Group

Zhu¹,

Ding²,

Bai³

et al. 2011

Haematologica

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“…It displays geographical and ethnic differences [2,3]. In Europe, for example, it is a major public health burden [4].…”

Section: Introductionmentioning

confidence: 99%

Pulmonary thromboembolism in an East African tertiary referral hospital

Ogeng’o

Obimbo

Olabu

et al. 2011

J Thromb Thrombolysis

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Pulmonary thromboembolism (PTE) is a frequent cause of mortality in Kenya, but its characteristics are hardly reported in Subsaharan Africa. To describe the pattern of PTE among black Africans, in a Kenyan referral hospital. Retrospective study at Kenyatta National Hospital (KNH), Nairobi, Kenya. Records of patients seen between January 2005 and December 2009 were examined for mode of diagnosis, comorbidities, age, gender, treatment and outcome. Data were analyzed using SPSS version 15.0 and are presented in tables and bar charts. One hundred and twenty-eight (60 male; 68 female) cases were analyzed. Diagnosis was made by clinical evaluation, a Well's score of >4.0, high D-dimer levels and ultrasound demonstration of a proximal deep venous thrombosis (DVT, 35.9%), lung spiral computer tomography (CT, 50%), multidetector CT (7.8%) and angiography (6.3%). Most frequent comorbidities included DVT (36%); hypertension (18.8%); pulmonary tuberculosis (PTB, 12.5%); HIV infection (10.9%), pueperium, diabetes mellitus and cigarette smoking (9.4% each). Mean age was 40.8 years (range 5-86 years) with a peak between 30 and 50 years. Over 46% of patients were aged 40 years and less. Male:female ratio was 1:1.13. All the patients were treated with anticoagulants and thrombolytics with only one having embolectomy. Ninety-two patients (71.9%) recovered, 18.8% of them with cor pulmonale, while 28.1% died. PTE is not uncommon in Kenya. It affects many individuals below 40 years without a gender bias, and carries high morbidity and mortality. Associated comorbidities include venous thrombosis, lifestyle conditions and communicable diseases. Control measures targeting both are recommended.

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“…Further, many studies were not able to evaluate whether differences in VTE risk factors explained any race association 6–8 . In order to determine the association of race and VTE and evaluate whether conventional VTE risk factors might mediate any observed differences, we assessed VTE incidence in blacks and whites in three large cohorts: the Cardiovascular Health Study (CHS), the Atherosclerosis Risk in Communities Study (ARIC), and the REasons for Geographic and Racial Differences in Stroke (REGARDS) study 10–13 .…”

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Racial and Regional Differences in Venous Thromboembolism in the United States in 3 Cohorts

et al. 2014

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Introduction Blacks are thought to have a higher risk of venous thromboembolism (VTE) than whites however prior studies are limited to administrative databases that lack specific information on VTE risk factors or have limited geographic scope. Methods and Results We ascertained VTE from three prospective studies; the Atherosclerosis Risk in Communities study (ARIC), the Cardiovascular Health Study (CHS), and the REasons for Geographic and Racial Differences in Stroke study (REGARDS). We tested the association of race with VTE using Cox proportional hazard models adjusted for VTE risk factors. Over 438,090 person-years, 916 incident VTE events (302 in blacks) occurred in 51,149 individuals (17,318 blacks) followed. In risk factor-adjusted models, blacks had a higher rate of VTE than whites in CHS (HR 1.81; 95% CI 1.20, 2.73) but not ARIC (HR 1.21; 95% CI 0.96, 1.54). In REGARDS, there was a significant region by race interaction (p = 0.01); blacks in the southeast had a significantly higher rate of VTE than blacks in the rest of the US (HR 1.63; 95% CI 1.08, 2.48) which was not seen in whites (HR 0.83; 95% CI 0.61, 1.14). Conclusions The association of race with VTE differed in each cohort, which may reflect the different time periods of the studies and/or different regional rates of VTE. Further study of environmental and genetic risk factors for VTE are needed to determine which underlie racial and perhaps regional differences in VTE.

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Pulmonary Thromboembolism in American Indians and Alaskan Natives

Abstract: The observed relatively low incidence of VTE in American Indians and Alaskan Natives would seem to be due to as yet undetermined genetic factors. The possibility that American Indians and Alaskan Natives have different lifestyles that affect the rate of diagnosis of VTE cannot be excluded.

Cited by 32 publications

References 13 publications

Normal ranges and genetic variants of antithrombin, protein C and protein S in the general Chinese population. Results of the Chinese Hemostasis Investigation on Natural Anticoagulants Study I Group

Normal ranges and genetic variants of antithrombin, protein C and protein S in the general Chinese population. Results of the Chinese Hemostasis Investigation on Natural Anticoagulants Study I Group

Pulmonary thromboembolism in an East African tertiary referral hospital

Racial and Regional Differences in Venous Thromboembolism in the United States in 3 Cohorts

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