Site of venous thromboembolism and prothrombotic mutations according to body mass index. Results from the EDITH study

Abstract

Summary This study evaluated the impact of body mass index (BMI) on venous thromboembolism (VTE) site and assessed a possible interaction between BMI and prothrombotic risk factors in patients included in the EDITH (Etude des Déterminants et Interactions de le THrombose veineuse) study. A cross‐sectional study was used to compare the site of unprovoked VTE according to BMI categories in 1077 patients and a matched case‐control study (732 pairs) assessed the joint effect of BMI and prothrombotic mutations on VTE risk. The cross sectional analysis showed that the proportion of patients with pulmonary embolism was higher in overweight (63%) and obese (63·5%) patients than among patients with a BMI < 25 kg/m2 (55%), P = 0·02 and P = 0·05 respectively. No interaction was found between F5 G1691A (factor V Leiden) and BMI for VTE risk (P = 0·90). There was a significant interaction between F2 G20210A and BMI (P = 0·02). The risk of VTE associated with BMI was 1·7 [95% confidence interval (CI): 0·8–3·7], 4·36 (95%CI: 1·49–12·78) and 12·03 (95%CI: 1·53–94·29) in patients with BMI < 25 kg/m2, 25 ≤ BMI < 30 and ≥30 kg/m2 respectively after adjustment for age and oestrogen use. This study showed that BMI may play a role in determining the site of VTE and may interact with F2 G20210A but not with F5 G1691A for the risk of VTE.

The effects of obesity on venous thromboembolism: A review

“…The data suggest FII G20210A mutation interacts with obesity to increase risk of VTE. However, the association between FVL and increasing BMI lacked statistical significance [55]. Similar findings have been reported by Severinsen et al, who analyzed the effects of the FVL and FII G20210A mutations on the risk of VTE among a subcohort of 1803 individuals randomly selected from the Danish Diet, Cancer, and Health Study [56].…”

“…However, the incidence rate of VTE among individuals with FVL and FII G20210A is highly variable, suggesting other factors might be involved in shaping the effects of these genetic factors. In a prospective case-control study consisting of 732 patients with unprovoked VTE and 732 individuals without VTE who were matched to the cases by age, sex, risk factor for VTE-surgery, plaster cast, pregnancy, childbirth in the past 3 months, and active cancer [55], Delluc et al reported an OR for VTE among patients with the FII G20210A mutation who were obese was 12.03 compared with the matched controls with the FII G20210A mutation who were obese. In contrast, the OR for VTE among patients with the FII G20210A mutation who had a BMI < 25 kg/m 2 was only 1.67 compared with the matched controls with the FII G20210A mutation who had a BMI < 25 kg/m 2 [55].…”

Risk factors for pregnancy-associated venous thromboembolism: a review

“…Obesity is associated clinically with a significantly elevated VTE risk, both in the non-pregnant patient [19] and during pregnancy and the puerperium [34,38]. A Danish group specifically sought to assess the association of obesity (BMI > 30 kg/m 2 ) and smoking on pregnancyassociated VTE risk in a population-based case-control study [35].…”

Body Mass Index, Surgery, and Risk of Venous Thromboembolism in Middle-Aged Women

“…First, it is a potentially avoidable and reversible condition that is steadily increasing in prevalence in many Ͻ25 ( parts of the world. 3 Second, in addition to independent effects on postoperative venous thromboembolism risk, it has been suggested that obesity interacts with other risk factors for venous thromboembolism, including inherited prothrombotic mutations 35,36 and acquired risk factors such as pregnancy, 37,38 oral contraceptive use, 39 and hormone replacement therapy. 33 Third, excess body weight has been reported to be associated with a higher risk of recurrent venous thromboembolism.…”