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Ageno W, Di Minno MND, Ay C, Jang MJ, Hansen JB, Steffen LM, Vayà A, Rattazzi M, Pabinger I, Oh D, Di Minno G, Braekkan SK, Cushman M, Bonet E, Pauletto P, Squizzato A, Dentali F. Association between the metabolic syndrome, its individual components, and unprovoked venous thromboembolism: results of a patient-level meta-analysis. Arterioscler Thromb Vasc Biol 2014; 34:2478-85. [PMID: 25212233 PMCID: PMC4322778 DOI: 10.1161/atvbaha.114.304085] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 08/27/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The metabolic syndrome (MetS) may contribute to the pathogenesis of venous thromboembolism (VTE), but this association requires additional investigation. APPROACH AND RESULTS We performed a patient-level meta-analysis of case-control and cohort studies that evaluated the role of MetS and risk of unprovoked VTE. For case-control studies, odds ratios and 95% confidence intervals were calculated using logistic regression analysis to estimate the influence of individual variables on the risk of VTE; χ(2) tests for trend were used to investigate the effect of increasing number of components of MetS on the risk of VTE and to explore the influence of abdominal obesity on this relationship. For cohort studies, hazard ratios and 95% confidence interval were calculated using multivariable Cox regression analysis. Six case-control studies were included (908 cases with unprovoked VTE and 1794 controls): in multivariate analysis, MetS was independently associated with VTE (odds ratio, 1.91; 95% confidence interval, 1.57-2.33), and both MetS and abdominal obesity were better predictors of unprovoked VTE than obesity defined by the body mass index. Two prospective cohort studies were included (26,531 subjects and 289 unprovoked VTE events): age, obesity, and abdominal obesity, but not MetS were associated with VTE. CONCLUSIONS Case-control but not prospective cohort studies support an association between MetS and VTE. Abdominal adiposity is a strong risk factor for VTE.
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Affiliation(s)
- Walter Ageno
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.).
| | - Matteo N D Di Minno
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Cihan Ay
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Moon Ju Jang
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - John-Bjarne Hansen
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Lyn M Steffen
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Amparo Vayà
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Marcello Rattazzi
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Ingrid Pabinger
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Doyeun Oh
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Giovanni Di Minno
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Sigrid K Braekkan
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Mary Cushman
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Elena Bonet
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Paolo Pauletto
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Alessandro Squizzato
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Francesco Dentali
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
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