Association of traditional cardiovascular risk factors with venous thromboembolism

Bakhtawar K. Mahmoodi; Mary Cushman; Inger Anne Næss; Matthew A. Allison; Willem Jan Bos; Sigrid K. Brækkan; Suzanne C. Cannegieter; Ron T. Gansevoort; Philimon N. Gona; Jens Hammerstrøm; John Bjarne Hansen; Susan Heckbert; Anders G. Holst; Susan G. Lakoski; Pamela L. Lutsey; Jo Ann E. Manson; Lisa W. Martin; Kunihiro Matsushita; Karina Meijer; Kim Overvad; Eva Prescott; Marja Puurunen; Jacques E. Rossouw; Yingying Sang; Marianne T. Severinsen; Jur Ten Berg; Aaron R. Folsom; Neil A. Zakai

doi:10.1161/circulationaha.116.024507

Association of traditional cardiovascular risk factors with venous thromboembolism

Bakhtawar K. Mahmoodi^*, Mary Cushman, Inger Anne Næss, Matthew A. Allison, Willem Jan Bos, Sigrid K. Brækkan, Suzanne C. Cannegieter, Ron T. Gansevoort, Philimon N. Gona, Jens Hammerstrøm, John Bjarne Hansen, Susan Heckbert, Anders G. Holst, Susan G. Lakoski, Pamela L. Lutsey, Jo Ann E. Manson, Lisa W. Martin, Kunihiro Matsushita, Karina Meijer, Kim OvervadEva Prescott, Marja Puurunen, Jacques E. Rossouw, Yingying Sang, Marianne T. Severinsen, Jur Ten Berg, Aaron R. Folsom, Neil A. Zakai

^*Corresponding author for this work

Department of Clinical Medicine

42 Citations (Scopus)

Abstract

Background: Much controversy surrounds the association of traditional cardiovascular disease risk factors with venous thromboembolism (VTE). Methods: We performed an individual level random-effect meta-analysis including 9 prospective studies with measured baseline cardiovascular disease risk factors and validated VTE events. Definitions were harmonized across studies. Traditional cardiovascular disease risk factors were modeled categorically and continuously using restricted cubic splines. Estimates were obtained for overall VTE, provoked VTE (ie, VTE occurring in the presence of 1 or more established VTE risk factors), and unprovoked VTE, pulmonary embolism, and deep-vein thrombosis. Results: The studies included 244 865 participants with 4910 VTE events occurring during a mean follow-up of 4.7 to 19.7 years per study. Age, sex, and body mass index-adjusted hazard ratios for overall VTE were 0.98 (95% confidence interval [CI]: 0.89-1.07) for hypertension, 0.97 (95% CI: 0.88-1.08) for hyperlipidemia, 1.01 (95% CI: 0.89-1.15) for diabetes mellitus, and 1.19 (95% CI: 1.08-1.32) for current smoking. After full adjustment, these estimates were numerically similar. When modeled continuously, an inverse association was observed for systolic blood pressure (hazard ratio=0.79 [95% CI: 0.68-0.92] at systolic blood pressure 160 vs 110 mm Hg) but not for diastolic blood pressure or lipid measures with VTE. An important finding from VTE subtype analyses was that cigarette smoking was associated with provoked but not unprovoked VTE. Fully adjusted hazard ratios for the associations of current smoking with provoked and unprovoked VTE were 1.36 (95% CI: 1.22-1.52) and 1.08 (95% CI: 0.90-1.29), respectively. Conclusions: Except for the association between cigarette smoking and provoked VTE, which is potentially mediated through comorbid conditions such as cancer, the modifiable traditional cardiovascular disease risk factors are not associated with increased VTE risk. Higher systolic blood pressure showed an inverse association with VTE.

Original language	English
Journal	Circulation
Volume	135
Issue number	1
Pages (from-to)	7-16
Number of pages	10
ISSN	0009-7322
DOIs	https://doi.org/10.1161/circulationaha.116.024507
Publication status	Published - 2017

Keywords

cardiovascular disease
diabetes mellitus
hyperlipidemia
hypertension
risk factors
smoking
venous thromboembolism

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Mahmoodi, B. K., Cushman, M., Næss, I. A., Allison, M. A., Bos, W. J., Brækkan, S. K., Cannegieter, S. C., Gansevoort, R. T., Gona, P. N., Hammerstrøm, J., Hansen, J. B., Heckbert, S., Holst, A. G., Lakoski, S. G., Lutsey, P. L., Manson, J. A. E., Martin, L. W., Matsushita, K., Meijer, K., ... Zakai, N. A. (2017). Association of traditional cardiovascular risk factors with venous thromboembolism. Circulation, 135(1), 7-16. https://doi.org/10.1161/circulationaha.116.024507

Mahmoodi, BK, Cushman, M, Næss, IA, Allison, MA, Bos, WJ, Brækkan, SK, Cannegieter, SC, Gansevoort, RT, Gona, PN, Hammerstrøm, J, Hansen, JB, Heckbert, S, Holst, AG, Lakoski, SG, Lutsey, PL, Manson, JAE, Martin, LW, Matsushita, K, Meijer, K, Overvad, K, Prescott, E, Puurunen, M, Rossouw, JE, Sang, Y, Severinsen, MT, Ten Berg, J, Folsom, AR & Zakai, NA 2017, 'Association of traditional cardiovascular risk factors with venous thromboembolism', Circulation, vol. 135, no. 1, pp. 7-16. https://doi.org/10.1161/circulationaha.116.024507

@article{4f66bd2b79294ae2b85b263dd802f8de,

title = "Association of traditional cardiovascular risk factors with venous thromboembolism",

abstract = "Background: Much controversy surrounds the association of traditional cardiovascular disease risk factors with venous thromboembolism (VTE). Methods: We performed an individual level random-effect meta-analysis including 9 prospective studies with measured baseline cardiovascular disease risk factors and validated VTE events. Definitions were harmonized across studies. Traditional cardiovascular disease risk factors were modeled categorically and continuously using restricted cubic splines. Estimates were obtained for overall VTE, provoked VTE (ie, VTE occurring in the presence of 1 or more established VTE risk factors), and unprovoked VTE, pulmonary embolism, and deep-vein thrombosis. Results: The studies included 244 865 participants with 4910 VTE events occurring during a mean follow-up of 4.7 to 19.7 years per study. Age, sex, and body mass index-adjusted hazard ratios for overall VTE were 0.98 (95% confidence interval [CI]: 0.89-1.07) for hypertension, 0.97 (95% CI: 0.88-1.08) for hyperlipidemia, 1.01 (95% CI: 0.89-1.15) for diabetes mellitus, and 1.19 (95% CI: 1.08-1.32) for current smoking. After full adjustment, these estimates were numerically similar. When modeled continuously, an inverse association was observed for systolic blood pressure (hazard ratio=0.79 [95% CI: 0.68-0.92] at systolic blood pressure 160 vs 110 mm Hg) but not for diastolic blood pressure or lipid measures with VTE. An important finding from VTE subtype analyses was that cigarette smoking was associated with provoked but not unprovoked VTE. Fully adjusted hazard ratios for the associations of current smoking with provoked and unprovoked VTE were 1.36 (95% CI: 1.22-1.52) and 1.08 (95% CI: 0.90-1.29), respectively. Conclusions: Except for the association between cigarette smoking and provoked VTE, which is potentially mediated through comorbid conditions such as cancer, the modifiable traditional cardiovascular disease risk factors are not associated with increased VTE risk. Higher systolic blood pressure showed an inverse association with VTE.",

keywords = "cardiovascular disease, diabetes mellitus, hyperlipidemia, hypertension, risk factors, smoking, venous thromboembolism",

author = "Mahmoodi, {Bakhtawar K.} and Mary Cushman and N{\ae}ss, {Inger Anne} and Allison, {Matthew A.} and Bos, {Willem Jan} and Br{\ae}kkan, {Sigrid K.} and Cannegieter, {Suzanne C.} and Gansevoort, {Ron T.} and Gona, {Philimon N.} and Jens Hammerstr{\o}m and Hansen, {John Bjarne} and Susan Heckbert and Holst, {Anders G.} and Lakoski, {Susan G.} and Lutsey, {Pamela L.} and Manson, {Jo Ann E.} and Martin, {Lisa W.} and Kunihiro Matsushita and Karina Meijer and Kim Overvad and Eva Prescott and Marja Puurunen and Rossouw, {Jacques E.} and Yingying Sang and Severinsen, {Marianne T.} and {Ten Berg}, Jur and Folsom, {Aaron R.} and Zakai, {Neil A.}",

year = "2017",

doi = "10.1161/circulationaha.116.024507",

language = "English",

volume = "135",

pages = "7--16",

journal = "Circulation",

issn = "0009-7322",

publisher = "AHA/ASA",

number = "1",

}

TY - JOUR

T1 - Association of traditional cardiovascular risk factors with venous thromboembolism

AU - Mahmoodi, Bakhtawar K.

AU - Cushman, Mary

AU - Næss, Inger Anne

AU - Allison, Matthew A.

AU - Bos, Willem Jan

AU - Brækkan, Sigrid K.

AU - Cannegieter, Suzanne C.

AU - Gansevoort, Ron T.

AU - Gona, Philimon N.

AU - Hammerstrøm, Jens

AU - Hansen, John Bjarne

AU - Heckbert, Susan

AU - Holst, Anders G.

AU - Lakoski, Susan G.

AU - Lutsey, Pamela L.

AU - Manson, Jo Ann E.

AU - Martin, Lisa W.

AU - Matsushita, Kunihiro

AU - Meijer, Karina

AU - Overvad, Kim

AU - Prescott, Eva

AU - Puurunen, Marja

AU - Rossouw, Jacques E.

AU - Sang, Yingying

AU - Severinsen, Marianne T.

AU - Ten Berg, Jur

AU - Folsom, Aaron R.

AU - Zakai, Neil A.

PY - 2017

Y1 - 2017

N2 - Background: Much controversy surrounds the association of traditional cardiovascular disease risk factors with venous thromboembolism (VTE). Methods: We performed an individual level random-effect meta-analysis including 9 prospective studies with measured baseline cardiovascular disease risk factors and validated VTE events. Definitions were harmonized across studies. Traditional cardiovascular disease risk factors were modeled categorically and continuously using restricted cubic splines. Estimates were obtained for overall VTE, provoked VTE (ie, VTE occurring in the presence of 1 or more established VTE risk factors), and unprovoked VTE, pulmonary embolism, and deep-vein thrombosis. Results: The studies included 244 865 participants with 4910 VTE events occurring during a mean follow-up of 4.7 to 19.7 years per study. Age, sex, and body mass index-adjusted hazard ratios for overall VTE were 0.98 (95% confidence interval [CI]: 0.89-1.07) for hypertension, 0.97 (95% CI: 0.88-1.08) for hyperlipidemia, 1.01 (95% CI: 0.89-1.15) for diabetes mellitus, and 1.19 (95% CI: 1.08-1.32) for current smoking. After full adjustment, these estimates were numerically similar. When modeled continuously, an inverse association was observed for systolic blood pressure (hazard ratio=0.79 [95% CI: 0.68-0.92] at systolic blood pressure 160 vs 110 mm Hg) but not for diastolic blood pressure or lipid measures with VTE. An important finding from VTE subtype analyses was that cigarette smoking was associated with provoked but not unprovoked VTE. Fully adjusted hazard ratios for the associations of current smoking with provoked and unprovoked VTE were 1.36 (95% CI: 1.22-1.52) and 1.08 (95% CI: 0.90-1.29), respectively. Conclusions: Except for the association between cigarette smoking and provoked VTE, which is potentially mediated through comorbid conditions such as cancer, the modifiable traditional cardiovascular disease risk factors are not associated with increased VTE risk. Higher systolic blood pressure showed an inverse association with VTE.

AB - Background: Much controversy surrounds the association of traditional cardiovascular disease risk factors with venous thromboembolism (VTE). Methods: We performed an individual level random-effect meta-analysis including 9 prospective studies with measured baseline cardiovascular disease risk factors and validated VTE events. Definitions were harmonized across studies. Traditional cardiovascular disease risk factors were modeled categorically and continuously using restricted cubic splines. Estimates were obtained for overall VTE, provoked VTE (ie, VTE occurring in the presence of 1 or more established VTE risk factors), and unprovoked VTE, pulmonary embolism, and deep-vein thrombosis. Results: The studies included 244 865 participants with 4910 VTE events occurring during a mean follow-up of 4.7 to 19.7 years per study. Age, sex, and body mass index-adjusted hazard ratios for overall VTE were 0.98 (95% confidence interval [CI]: 0.89-1.07) for hypertension, 0.97 (95% CI: 0.88-1.08) for hyperlipidemia, 1.01 (95% CI: 0.89-1.15) for diabetes mellitus, and 1.19 (95% CI: 1.08-1.32) for current smoking. After full adjustment, these estimates were numerically similar. When modeled continuously, an inverse association was observed for systolic blood pressure (hazard ratio=0.79 [95% CI: 0.68-0.92] at systolic blood pressure 160 vs 110 mm Hg) but not for diastolic blood pressure or lipid measures with VTE. An important finding from VTE subtype analyses was that cigarette smoking was associated with provoked but not unprovoked VTE. Fully adjusted hazard ratios for the associations of current smoking with provoked and unprovoked VTE were 1.36 (95% CI: 1.22-1.52) and 1.08 (95% CI: 0.90-1.29), respectively. Conclusions: Except for the association between cigarette smoking and provoked VTE, which is potentially mediated through comorbid conditions such as cancer, the modifiable traditional cardiovascular disease risk factors are not associated with increased VTE risk. Higher systolic blood pressure showed an inverse association with VTE.

KW - cardiovascular disease

KW - diabetes mellitus

KW - hyperlipidemia

KW - hypertension

KW - risk factors

KW - smoking

KW - venous thromboembolism

U2 - 10.1161/circulationaha.116.024507

DO - 10.1161/circulationaha.116.024507

M3 - Journal article

C2 - 27831499

AN - SCOPUS:84996866012

SN - 0009-7322

VL - 135

SP - 7

EP - 16

JO - Circulation

JF - Circulation

IS - 1

ER -

Association of traditional cardiovascular risk factors with venous thromboembolism

Abstract

Keywords

UN SDGs

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