Cardiovascular Risk Factors Associated With Venous Thromboembolism

Emerging Risk Factors Collaboration, Graeme Hankey

Research output: Contribution to journalArticle

10 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)163-173
Number of pages11
JournalJAMA Cardiology
Volume4
Issue number2
DOIs
Publication statusPublished - 1 Feb 2019

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Venous Thromboembolism
Adiposity
Pulmonary Embolism
Coronary Disease
Body Mass Index
Fatal Outcome
Smoking
Venous Thrombosis
Aptitude
Cohort Studies
Cardiovascular Diseases
Outcome Assessment (Health Care)
Blood Pressure
Inflammation
Lipids
Surveys and Questionnaires
Population

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Emerging Risk Factors Collaboration ; Hankey, Graeme. / Cardiovascular Risk Factors Associated With Venous Thromboembolism. In: JAMA Cardiology. 2019 ; Vol. 4, No. 2. pp. 163-173.
@article{ddebe1b1143f4e29b6e78ebaaf051c84,
title = "Cardiovascular Risk Factors Associated With Venous Thromboembolism",
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.",
author = "{Emerging Risk Factors Collaboration} and John Gregson and Stephen Kaptoge and Thomas Bolton and Lisa Pennells and Peter Willeit and Stephen Burgess and Steven Bell and Michael Sweeting and Rimm, {Eric B} and Christopher Kabrhel and Bengt Z{\"o}ller and Gerd Assmann and Vilmundur Gudnason and Folsom, {Aaron R} and Volker Arndt and Astrid Fletcher and Norman, {Paul E} and Nordestgaard, {B{\o}rge G} and Akihiko Kitamura and Mahmoodi, {Bakhtawar K} and Whincup, {Peter H} and Matthew Knuiman and Veikko Salomaa and Christa Meisinger and Wolfgang Koenig and Maryam Kavousi and Henry V{\"o}lzke and Cooper, {Jackie A} and Toshiharu Ninomiya and Edoardo Casiglia and Beatriz Rodriguez and Yoav Ben-Shlomo and Jean-Pierre Despr{\'e}s and Leon Simons and Elizabeth Barrett-Connor and Cecilia Bj{\"o}rkelund and Marlene Notdurfter and Daan Kromhout and Jackie Price and Sutherland, {Susan E} and Johan Sundstr{\"o}m and Jussi Kauhanen and John Gallacher and Beulens, {Joline W J} and Rachel Dankner and Cyrus Cooper and Simona Giampaoli and Deen, {Jason F} and {G{\'o}mez de la C{\'a}mara}, Agust{\'i}n and Kuller, {Lewis H} and Annika Rosengren and Svensson, {Peter J} and Dorothea Nagel and Crespo, {Carlos J} and Hermann Brenner and Albertorio-Diaz, {Juan R} and Robert Atkins and Brunner, {Eric J} and Martin Shipley and Inger Nj{\o}lstad and Lawlor, {Deborah A} and {van der Schouw}, {Yvonne T} and Selmer, {Randi Marie} and Maurizio Trevisan and Verschuren, {W M Monique} and Philip Greenland and Sylvia Wassertheil-Smoller and Lowe, {Gordon D O} and Wood, {Angela M} and Butterworth, {Adam S} and Thompson, {Simon G} and John Danesh and {Di Angelantonio}, Emanuele and Tom Meade and Graeme Hankey",
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Cardiovascular Risk Factors Associated With Venous Thromboembolism. / Emerging Risk Factors Collaboration ; Hankey, Graeme.

In: JAMA Cardiology, Vol. 4, No. 2, 01.02.2019, p. 163-173.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cardiovascular Risk Factors Associated With Venous Thromboembolism

AU - Emerging Risk Factors Collaboration

AU - Gregson, John

AU - Kaptoge, Stephen

AU - Bolton, Thomas

AU - Pennells, Lisa

AU - Willeit, Peter

AU - Burgess, Stephen

AU - Bell, Steven

AU - Sweeting, Michael

AU - Rimm, Eric B

AU - Kabrhel, Christopher

AU - Zöller, Bengt

AU - Assmann, Gerd

AU - Gudnason, Vilmundur

AU - Folsom, Aaron R

AU - Arndt, Volker

AU - Fletcher, Astrid

AU - Norman, Paul E

AU - Nordestgaard, Børge G

AU - Kitamura, Akihiko

AU - Mahmoodi, Bakhtawar K

AU - Whincup, Peter H

AU - Knuiman, Matthew

AU - Salomaa, Veikko

AU - Meisinger, Christa

AU - Koenig, Wolfgang

AU - Kavousi, Maryam

AU - Völzke, Henry

AU - Cooper, Jackie A

AU - Ninomiya, Toshiharu

AU - Casiglia, Edoardo

AU - Rodriguez, Beatriz

AU - Ben-Shlomo, Yoav

AU - Després, Jean-Pierre

AU - Simons, Leon

AU - Barrett-Connor, Elizabeth

AU - Björkelund, Cecilia

AU - Notdurfter, Marlene

AU - Kromhout, Daan

AU - Price, Jackie

AU - Sutherland, Susan E

AU - Sundström, Johan

AU - Kauhanen, Jussi

AU - Gallacher, John

AU - Beulens, Joline W J

AU - Dankner, Rachel

AU - Cooper, Cyrus

AU - Giampaoli, Simona

AU - Deen, Jason F

AU - Gómez de la Cámara, Agustín

AU - Kuller, Lewis H

AU - Rosengren, Annika

AU - Svensson, Peter J

AU - Nagel, Dorothea

AU - Crespo, Carlos J

AU - Brenner, Hermann

AU - Albertorio-Diaz, Juan R

AU - Atkins, Robert

AU - Brunner, Eric J

AU - Shipley, Martin

AU - Njølstad, Inger

AU - Lawlor, Deborah A

AU - van der Schouw, Yvonne T

AU - Selmer, Randi Marie

AU - Trevisan, Maurizio

AU - Verschuren, W M Monique

AU - Greenland, Philip

AU - Wassertheil-Smoller, Sylvia

AU - Lowe, Gordon D O

AU - Wood, Angela M

AU - Butterworth, Adam S

AU - Thompson, Simon G

AU - Danesh, John

AU - Di Angelantonio, Emanuele

AU - Meade, Tom

AU - Hankey, Graeme

PY - 2019/2/1

Y1 - 2019/2/1

N2 - 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.

AB - 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.

U2 - 10.1001/jamacardio.2018.4537

DO - 10.1001/jamacardio.2018.4537

M3 - Article

VL - 4

SP - 163

EP - 173

JO - JAMA Cardiology

JF - JAMA Cardiology

SN - 2380-6583

IS - 2

ER -