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 E., Nordestgaard, Borge G., Kitamura, Akihiko, Mahmoodi, Bakhtawar K., Whincup, Peter H., Knuiman, Matthew, Salomaa, Veikko, Meisinger, Christa, Koenig, Wolfgang, Kavousi, Maryam, Voelzke, Henry, Cooper, Jackie A., Ninomiya, Toshiharu, Casiglia, Edoardo, Rodriguez, Beatriz, Ben-Shlomo, Yoav, Despres, Jean-Pierre, Simons, Leon, Barrett-Connor, Elizabeth, Bjorkelund, Cecilia, Notdurfter, Marlene, Kromhout, Daan, Price, Jackie, Sutherland, Susan E., Sundstroem, Johan, Kauhanen, Jussi, Gallacher, John, Beulens, Joline W.J., Dankner, Rachel, Cooper, Cyrus, Giampaoli, Simona, Deen, Jason F., Gomez de la Camara, Agustin, Kuller, Lewis H., Rosengren, Annika, Svensson, Peter J., Nagel, Dorothea, Crespo, Carlos J., Brenner, Hermann, Albertorio-Diaz, Juan R., Atkins, Robert, Brunner, Eric J., Shipley, Martin, Njølstad, Inger, Lawlor, Deborah A., van der Schouw, Yvonne T., Selmer, Randi Marie, Trevisan, Maurizio, Verschuren, W.M. Monique, Greenland, Philip, Wassertheil-Smoller, Sylvia, Lowe, Gordon D.O., Wood, Angela M., Butterworth, Adam S., Thompson, Simon G., Danesh, John, Di Angelantonio, Emanuele, Meade, Tom, and Emerging Risk Factors Collaboration, (2019) Cardiovascular risk factors associated with venous thromboembolism. Jama Cardiology, 4 (2). pp. 163-173.

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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.

Item ID: 57410
Item Type: Article (Research - C1)
ISSN: 2380-6591
Copyright Information: Copyright © 2019 Gregson J et al. JAMA Cardiology. This is an open access article distributed under the terms of the CC-BY License.
Additional Information:

Jonathan Golledge is part of the Emerging Risk Factors Collaboration group. All collaborators are listed at the end of the article.

Funders: UK Medical Research Council (MRC), British Heart Foundation (BHF), British Heart Foundation Cambridge Cardiovascular Centre of Excellence, UK National Institute for Health Research Cambridge Biomedical Research Centre, European Research Council (ERC), European Commission (EC), Health Data Research UK
Projects and Grants: MRC grant G0800270, BHF grant SP/09/002, ERC grant 268834, EC Framework Programme 7 grant HEALTH-F2-2012-279233
Date Deposited: 13 Mar 2019 07:34
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1102 Cardiovascular Medicine and Haematology > 110299 Cardiovascular Medicine and Haematology not elsewhere classified @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920199 Clinical Health (Organs, Diseases and Abnormal Conditions) not elsewhere classified @ 100%
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