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Ding C, Guo C, Du D, Gong X, Yuan Y. Association between diabetes and venous thromboembolism: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e35329. [PMID: 37861548 PMCID: PMC10589568 DOI: 10.1097/md.0000000000035329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/31/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) plays a vital role in the development of cardiovascular disease. However, its association with venous thromboembolism (VTE) remains unclear, for the published study results are conflicting. We performed a meta-analysis of published cohort studies and case-control studies to assess the role of DM in the formation and prognosis of VTE. METHODS PubMed and EMBASE databases were searched for articles from the database's establishment until September 15, 2022. Of the 15,754 publications retrieved, 50 studies were identified that met the selection criteria. The New castle-Ottawa Scale was used to evaluate the quality of the literature. Pooled odds ratios (ORs) and 95% confidence intervals were calculated using fixed- or random-effect models. RESULTS We combined OR using a random-effects or fixed-effects model: patients with DM had an increased risk of VTE (OR 1.27, 95% confidence interval [CI]: 1.15-1.41), which still showed a partial association in studies adjusted by confounding factors (OR 1.20, 95% CI: 1.07-1.35). DM was not significantly associated with VTE when analyzed in studies adjusted by body mass index (OR 1.04, 95% CI: 0.94-1.15). VTE patients with DM had a higher risk of short-term and long-term mortality than those without DM (OR 1.58 [95% CI: 1.26-1.99] for long-term mortality and OR 1.20 [95% CI: 1.19-1.21] for short-term mortality). CONCLUSION There was no significant association between DM and VTE risk, and body mass index may be a significant confounding factor between DM and VTE risk. However, DM can still lead to an increased risk of long-term and short-term mortality in patients with VTE.
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Affiliation(s)
- Chaowei Ding
- Department of Respiratory and Critical Care Medicine, Xiamen Humanity Hospital Fujian Medical University, Xiamen, Fujian, China
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Chang Guo
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Dan Du
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Xiaowei Gong
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Yadong Yuan
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
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Keller K, Kohring C, Farmakis IT, Valerio L, Barco S, Bätzing J, Akmatov MK, Konstantinides S, Münzel T, Hobohm L, Holstiege J. Impact of venous thromboembolism on incidence of arterial thromboembolism - An analysis of German outpatient claims data. Thromb Res 2023; 226:9-17. [PMID: 37079980 DOI: 10.1016/j.thromres.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/10/2023] [Accepted: 04/07/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) and arterial thromboembolism (ATE) are considered as two separate disease-entities. In recent years, studies have reported clear associations between VTE and atherosclerosis. We aimed to evaluate the long-term risk of ATE in VTE patients in comparison to controls without VTE. METHODS Nationwide outpatient claims data of all inhabitants with statutory health insurance in Germany were used for secondary data analysis between the years 2011 and 2020. Patients treated in 2013 were stratified by VTE event, and groups were 1:2-matched by age and sex. The hazard for an ATE event in a 5-year follow-up period between patients with and without VTE was calculated with multivariable Cox regression adjusted for age, sex, cardiovascular risk factors, and comorbidities. RESULTS Of 69,699,277 individuals treated in the year 2013 by German physicians in outpatient care, in total 686,382 individuals (age 59.8 ± 17.5 years, 65.4 % females) were included comprising 228,794 patients with VTE and 457,588 controls without VTE. VTE patients more often had cardiovascular risk factors (81.6 % vs. 62.2 %) and traditional VTE risk factors. The occurrence of ATE events during follow-up was 1.8 %-points higher in VTE patients in comparison to the controls (9.7 % vs. 7.9 %). VTE events were independently associated with increased occurrence of ATE events within follow-up (HRadjusted 1.19 [99%CI 1.16-1.23], p < 0.0001). CONCLUSIONS Patients with a VTE event have an increased long-term risk for subsequent arterial cardiovascular events. Large prospective cohorts are needed to identify patient subgroups with a very high ATE risk after VTE.
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Affiliation(s)
- Karsten Keller
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, Heidelberg, Germany.
| | - Claudia Kohring
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Ioannis T Farmakis
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Luca Valerio
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Stefano Barco
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Jörg Bätzing
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Manas K Akmatov
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Lukas Hobohm
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Jakob Holstiege
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care, Berlin, Germany
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Keller K, Prochaska JH, Coldewey M, Göbel S, Schmitt VH, Hahad O, Ullmann A, Nagler M, Lamparter H, Espinola-Klein C, Münzel T, Wild PS. Atherosclerosis and Its Impact on the Outcomes of Patients with Deep Venous Thrombosis. Life (Basel) 2022; 12:life12050734. [PMID: 35629401 PMCID: PMC9143312 DOI: 10.3390/life12050734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 01/10/2023] Open
Abstract
Introduction: Atherosclerosis and pulmonary embolism (PE) affect cardiovascular mortality substantially. We aimed to investigate the impact of atherosclerosis on the outcomes of patients with deep venous thrombosis (DVT) and to identify the differences in DVT patients with and without PE. Methods: Patients with DVT with and without symptomatic atherosclerosis (defined as coronary artery disease, myocardial infarction and/or peripheral artery disease) as well as with and without PE under oral anticoagulation were enrolled during January 2011−April 2013 and compared. The impact of symptomatic atherosclerosis on several outcomes was analyzed. Results: Overall, 509 DVT patients (70.0 [56.0−77.0] years, 51.9% females) were included in this study. Among them, 179 (36.3%) had symptomatic atherosclerosis and 204 (40.1%) a concomitant PE. DVT patients with symptomatic atherosclerosis were older (74.0 [IQR 65.0−80.0] vs. 63.0 [48.0−75.0] years, p < 0.0001), more often male (56.4% vs. 43.9%, p = 0.0087) and had a higher prevalence of classical CVRF and a higher Charlson comorbidity index (7.00 [5.00−8.00] vs. 4.00 [2.00−6.00], p < 0.001). Symptomatic atherosclerosis was associated with increased mortality (HR 1.98 [95%CI 1.12−3.49], p = 0.018) and hospitalizations (HR 1.64 [95%CI 1.21−2.21], p = 0.0012) and primary long-term outcome (HR 1.99 [95%CI 1.31−3.04], p = 0.0013) during the 2 years follow-up-period in DVT patients. DVT patients without PE had diabetes mellitus (28.2% vs. 16.3%, p < 0.01) and symptomatic atherosclerosis (42.9% vs. 26.4%, p < 0.001) more often compared to DVT patients with PE, and symptomatic atherosclerosis was associated with isolated DVT (without PE) (OR 2.01 [95%CI 1.28−3.16], p < 0.01). Conclusions: Atherosclerosis was associated with isolated DVT (without PE) and increased mortality in DVT patients under oral anticoagulation. The profile of CVRF and comorbidities differed between DVT patients with and without a concomitant PE. In the case of DVT or PE, patients should be screened for concomitant atherosclerotic disease. Clinical Trial Registration: at clinicaltrials with Unique identifier NCT01809015.
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Affiliation(s)
- Karsten Keller
- Department of Cardiology, University Medical Center Mainz of Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (M.C.); (S.G.); (V.H.S.); (O.H.); (C.E.-K.); (T.M.)
- Center for Thrombosis and Hemostasis, University Medical Center Mainz of Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (J.H.P.); (A.U.); (M.N.); (H.L.); (P.S.W.)
- Department of Sports Medicine, Medical Clinic VII, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Correspondence:
| | - Jürgen H. Prochaska
- Center for Thrombosis and Hemostasis, University Medical Center Mainz of Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (J.H.P.); (A.U.); (M.N.); (H.L.); (P.S.W.)
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein Main, 55131 Mainz, Germany
| | - Meike Coldewey
- Department of Cardiology, University Medical Center Mainz of Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (M.C.); (S.G.); (V.H.S.); (O.H.); (C.E.-K.); (T.M.)
- Center for Thrombosis and Hemostasis, University Medical Center Mainz of Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (J.H.P.); (A.U.); (M.N.); (H.L.); (P.S.W.)
| | - Sebastian Göbel
- Department of Cardiology, University Medical Center Mainz of Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (M.C.); (S.G.); (V.H.S.); (O.H.); (C.E.-K.); (T.M.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein Main, 55131 Mainz, Germany
| | - Volker H. Schmitt
- Department of Cardiology, University Medical Center Mainz of Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (M.C.); (S.G.); (V.H.S.); (O.H.); (C.E.-K.); (T.M.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein Main, 55131 Mainz, Germany
| | - Omar Hahad
- Department of Cardiology, University Medical Center Mainz of Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (M.C.); (S.G.); (V.H.S.); (O.H.); (C.E.-K.); (T.M.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein Main, 55131 Mainz, Germany
- Leibniz Institute for Resilience Research (LIR), 55131 Mainz, Germany
| | - Alexander Ullmann
- Center for Thrombosis and Hemostasis, University Medical Center Mainz of Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (J.H.P.); (A.U.); (M.N.); (H.L.); (P.S.W.)
| | - Markus Nagler
- Center for Thrombosis and Hemostasis, University Medical Center Mainz of Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (J.H.P.); (A.U.); (M.N.); (H.L.); (P.S.W.)
| | - Heidrun Lamparter
- Center for Thrombosis and Hemostasis, University Medical Center Mainz of Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (J.H.P.); (A.U.); (M.N.); (H.L.); (P.S.W.)
| | - Christine Espinola-Klein
- Department of Cardiology, University Medical Center Mainz of Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (M.C.); (S.G.); (V.H.S.); (O.H.); (C.E.-K.); (T.M.)
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz of Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (M.C.); (S.G.); (V.H.S.); (O.H.); (C.E.-K.); (T.M.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein Main, 55131 Mainz, Germany
| | - Philipp S. Wild
- Center for Thrombosis and Hemostasis, University Medical Center Mainz of Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (J.H.P.); (A.U.); (M.N.); (H.L.); (P.S.W.)
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein Main, 55131 Mainz, Germany
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Sejrup JK, Morelli VM, Løchen M, Njølstad I, Mathiesen EB, Wilsgaard T, Hansen J, Brækkan SK. Myocardial infarction, prothrombotic genotypes, and venous thrombosis risk: The Tromsø Study. Res Pract Thromb Haemost 2020; 4:247-254. [PMID: 32110755 PMCID: PMC7040547 DOI: 10.1002/rth2.12306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/28/2019] [Accepted: 12/26/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The risk of venous thromboembolism (VTE) is increased after a myocardial infarction (MI). Some prothrombotic genotypes associated with VTE have also been associated with risk of MI. Whether prothrombotic single-nucleotide polymorphisms (SNPs) further increase the risk of VTE in MI patients is scarcely investigated. AIM To study the combined effect of MI and prothrombotic SNPs on the risk of VTE. METHODS Cases with incident VTE (n = 641) and a randomly sampled subcohort weighted for age (n = 1761) were identified from the 4 to 6 surveys of the Tromsø Study (1994-2012). DNA was genotyped for rs8176719 (ABO), rs6025 (F5), rs1799963 (F2), rs2066865 (FGG), and rs2036914 (F11). Hazard ratios (HRs) for VTE with 95% confidence intervals (CIs) were estimated by categories of risk alleles and MI status. RESULTS Patients with MI had a 1.4-fold increased risk of VTE, and adjustments for the 5 SNPs, either alone or in combination, did not affect this relationship (adjusted HR, 1.52; 95% CI, 1.12-2.07). In subjects without MI, an increased risk of VTE was observed for each of the individual SNPs (≥1 vs. 0 risk alleles), and the risk increased linearly with increasing number of risk alleles in the 5-SNP score. The combination of MI and prothrombotic genotypes, either as individual SNPs or in the 5-SNP score, did not result in an excess risk of VTE. CONCLUSION The relationship between MI and VTE was not explained by these 5 prothrombotic genotypes. Prothrombotic genotypes did not yield an excess risk of VTE in patients with MI.
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Affiliation(s)
- Joakim K. Sejrup
- K.G. Jebsen‐Thrombosis Research and Expertise Center (TREC)Department of Clinical MedicineUiT The Arctic University of NorwayTromsøNorway
| | - Vania M. Morelli
- K.G. Jebsen‐Thrombosis Research and Expertise Center (TREC)Department of Clinical MedicineUiT The Arctic University of NorwayTromsøNorway
| | - Maja‐Lisa Løchen
- Department of Community MedicineEpidemiology of Chronic Diseases Research GroupUiT The Arctic University of NorwayTromsøNorway
| | - Inger Njølstad
- Department of Community MedicineEpidemiology of Chronic Diseases Research GroupUiT The Arctic University of NorwayTromsøNorway
| | - Ellisiv B. Mathiesen
- Brain and Circulation Research GroupDepartment of Clinical MedicineUiT The Arctic University of NorwayTromsøNorway
| | - Tom Wilsgaard
- Department of Community MedicineEpidemiology of Chronic Diseases Research GroupUiT The Arctic University of NorwayTromsøNorway
| | - John‐Bjarne Hansen
- K.G. Jebsen‐Thrombosis Research and Expertise Center (TREC)Department of Clinical MedicineUiT The Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
| | - Sigrid K. Brækkan
- K.G. Jebsen‐Thrombosis Research and Expertise Center (TREC)Department of Clinical MedicineUiT The Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
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Småbrekke B, Rinde LB, Evensen LH, Morelli VM, Hveem K, Gabrielsen ME, Njølstad I, Mathiesen EB, Rosendaal FR, Braekkan SK, Hansen JB. Impact of prothrombotic genotypes on the association between family history of myocardial infarction and venous thromboembolism. J Thromb Haemost 2019; 17:1363-1371. [PMID: 31124268 DOI: 10.1111/jth.14493] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/15/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Family history of myocardial infarction (FHMI) is known to increase the risk of venous thromboembolism (VTE). OBJECTIVES To investigate the effect of prothrombotic genotypes on the association between FHMI and VTE in a case-cohort recruited from a general population. METHODS Cases with a first VTE (n = 1493) and a subcohort (n = 13 072) were sampled from the Tromsø study (1994-2012) and the Nord-Trøndelag health (HUNT) study (1995-2008). The DNA samples were genotyped for rs8176719 (ABO), rs6025 (F5), rs1799963 (F2), rs2066865 (FGG), and rs2036914 (F11). Participants with missing information on risk alleles (n = 175), FHMI (n = 2769), and BMI (n = 52) were excluded. Cox regression models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CI) for VTE. To explore the role of prothrombotic genotypes for the association between FHMI and VTE, we (a) included the genotypes in the multivariable-adjusted models and (b) assessed the joint effects between FHMI and genotypes on VTE risk. RESULTS The FHMI was associated with a 1.3-fold increased risk of VTE (HR 1.32, 95% CI 1.16-1.50) and 1.5-fold increased risk of unprovoked VTE (HR 1.47, 95% CI 1.22-1.78). The risk of VTE by FHMI did not alter after adjustment for the five genotypes. The combination of FHMI and the different prothrombotic genotypes did not result in an excess VTE risk (i.e. no biological interaction). CONCLUSIONS Our findings suggest that the risk of VTE by FHMI is not explained by rs8176719 (ABO), rs6025 (F5), rs1799963 (F2), rs2066865 (FGG), and rs2036914 (F11). The combination of FHMI with prothrombotic genotypes had an additive effect on VTE risk.
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Affiliation(s)
- Birgit Småbrekke
- K. G. Jebsen - Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ludvig B Rinde
- K. G. Jebsen - Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Line H Evensen
- K. G. Jebsen - Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Vania M Morelli
- K. G. Jebsen - Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Kristian Hveem
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health, Norwegian University of Science and Technology, Trondheim, Norway
- HUNT Research Center, Department of Public Health, Norwegian University of Science and Technology, Levanger, Norway
| | - Maiken E Gabrielsen
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Inger Njølstad
- K. G. Jebsen - Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ellisiv B Mathiesen
- K. G. Jebsen - Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Brain and Circulation Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Frits R Rosendaal
- K. G. Jebsen - Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Sigrid K Braekkan
- K. G. Jebsen - Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - John-Bjarne Hansen
- K. G. Jebsen - Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
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Impact of symptomatic atherosclerosis in patients with pulmonary embolism. Int J Cardiol 2018; 278:225-231. [PMID: 30558990 DOI: 10.1016/j.ijcard.2018.12.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 11/19/2018] [Accepted: 12/04/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Atherosclerosis is associated with increased cardiovascular mortality. Associations between venous thromboembolism and atherosclerosis were recently reported. We aimed to investigate the impact of symptomatic atherosclerosis on adverse outcomes in patients with pulmonary embolism (PE) and to identify significant differences among patients with PE stratified by symptomatic atherosclerosis. METHODS Patients were selected by screening the nationwide inpatients sample for PE (ICD-code I26) stratified by symptomatic atherosclerosis (composite of coronary artery disease [ICD-code I25], myocardial infarction [ICD-code I21], ischemic stroke [ICD-code I63], and/or atherosclerotic arterial diseases [ICD-code I70]). We compared PE patients with (PE + Athero) and without (PE - Athero) symptomatic atherosclerosis and analysed the impact of symptomatic atherosclerosis on adverse outcomes. RESULTS Overall, 213,995 patients with PE (54.2% females) were included in this analysis. Of these, 30,157 (14.1%) had symptomatic atherosclerosis with age-dependent incline. Deep vein thrombosis or thrombophlebitis (45.1% vs. 36.9%, P < 0.001) was more commonly observed in the PE - Athero group (Odds Ratio (OR) 0.713 [95% CI 0.695-0.731], P < 0.001). In-hospital mortality (12.1% vs. 9.6%, P < 0.001) and adverse in-hospital events (16.8% vs. 12.6%, P < 0.001) were affected by symptomatic atherosclerosis; both in-hospital mortality (OR 1.107 [95% CI 1.061-1.155], P < 0.001) and adverse in-hospital outcomes (OR 1.143 [95%CI 1.102-1.186], P < 0.001) were affected independently of age, gender, comorbidities, and reperfusion treatments. CONCLUSIONS Symptomatic atherosclerosis in patients with PE increased with age and was associated with a poorer outcome. Cardiovascular-atherosclerotic diseases might play a major role in thrombus formation in isolated PE.
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Li X, Ohlsson H, Ji J, Sundquist J, Sundquist K, Zöller B. Family history of venous thromboembolism as a risk factor and genetic research tool. Thromb Haemost 2017; 114:890-900. [DOI: 10.1160/th15-04-0306] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/03/2015] [Indexed: 12/25/2022]
Abstract
SummaryFamilial clustering of venous thromboembolism (VTE) was described as far back as 1905 by Briggs. Although Egeberg discovered inherited deficiency of antithrombin in 1965, it was not until Dahlback discovered resistance to activated protein C in 1993 that it became clear that genetic factors are common risk factors of VTE. Several genes have been linked to familial aggregation of VTE and genome-wide association studies have found several novel gene loci. Still, it has been estimated that much of the heritability for VTE remains to be discovered. Family history (FH) of VTE is therefore still important to determine whether a patient has an increased genetic risk of VTE. FH has the potential to represent the sum of effects and interactions between environmental and genetic factors. In this article the design, methodology, results, clinical and genetic implications of FH studies of VTE are reviewed. FH in first-degree relatives (siblings and/or parents) is associated with a 2–3 times increased familial relative risk (FRR). However, the FRR is dependent on age, number of affected relatives, and presentation of VTE (provoked/unprovoked). Especially high familial risks are observed in individuals with two or more affected siblings (FFR> 50). However, the familial risk for recurrent VTE is much lower or non-significant. Moreover, FH of VTE appears mainly to be important for venous diseases (i. e. VTE and varicose veins). The familial associations with other diseases are weaker. In conclusion, FH of VTE is an important research tool and a clinically potential useful risk factor for VTE.
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Keller K, Prochaska JH, Coldewey M, Gobel S, Ullmann A, Jünger C, Lamparter H, Ariza L, Bickel C, Lauterbach M, Konstantinides S, Rostock T, Münzel T, Wild PS. History of deep vein thrombosis is a discriminator for concomitant atrial fibrillation in pulmonary embolism. Thromb Res 2015; 136:899-906. [PMID: 26376038 DOI: 10.1016/j.thromres.2015.08.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 08/22/2015] [Accepted: 08/29/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND Pulmonary embolism (PE) is the consequence of deep vein thrombosis (DVT) in 70% of all cases. Although, PE and DVT are commonly related to risk factors of Virchow's triad, both entities are linked to cardiovascular risk factors, but risk factors seem differently important in both entities. OBJECTIVES We aimed to investigate clinical profile and outcome of patients with PE history stratified by concomitant DVT. PATIENTS/METHODS Data from the observational multi-center thrombEVAL-study were analyzed. RESULTS The sample (N=2,318) comprised 295 PE patients, of whom 69.2% (N=204) had DVT. Individuals without DVT were older and had higher prevalence of concomitant atrial fibrillation (AF), chronic lung diseases, coronary artery disease, heart failure and hypertension. Multivariable regression revealed an independent association of AF (Odds Ratio (OR) 3.17, 95% CI 1.63-6.18, P<0.001) and coronary artery disease (OR 2.31, 95% CI 1.15-4.66, P=0.019) with PE without DVT. There was higher frequency of permanent AF in individuals without DVT, whereas paroxysmal AF was more prevalent in individuals with DVT. All AF subtypes were independently associated with PE without DVT with increasing ORs from paroxysmal to permanent AF. PE patients with and without DVT did not differ in survival (P=0.32) and cost-relevant clinical outcome (P=0.26) during follow-up. AF in PE patients was associated with cost-relevant clinical outcome (Hazard Ratio (HR) 1.78, 95% CI 1.03-3.09, P=0.040), but no significant difference in survival (HR 0.93, 95% CI 0.35-2.50, P=0.88) was observed. CONCLUSIONS History of DVT is a significant discriminator for clinical profile of PE patients. Individuals without DVT had more often cardiac and pulmonary disease with strongest association with AF. Data advocate a potential link between AF and PE. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov, Unique identifier NCT01809015.
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Affiliation(s)
- Karsten Keller
- Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany; Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jürgen H Prochaska
- Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany; Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Meike Coldewey
- Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany; Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sebastian Gobel
- Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany; Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Germany
| | - Alexander Ullmann
- Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany
| | - Claus Jünger
- Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany
| | - Heidrun Lamparter
- Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany
| | - Liana Ariza
- Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany
| | - Christoph Bickel
- Department of Medicine I, Federal Armed Forces Central Hospital Koblenz, Koblenz, Germany
| | - Michael Lauterbach
- Department of Internal Medicine III, Hospital of Barmherzige Brüder Trier, Trier, Germany
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany; Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Rostock
- Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Münzel
- Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany; Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Germany
| | - Philipp S Wild
- Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany; Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Germany; Preventive Cardiology and Preventive Medicine, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany.
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Bai J, Ding X, Du X, Zhao X, Wang Z, Ma Z. Diabetes is associated with increased risk of venous thromboembolism: a systematic review and meta-analysis. Thromb Res 2014; 135:90-5. [PMID: 25434631 DOI: 10.1016/j.thromres.2014.11.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 11/02/2014] [Accepted: 11/05/2014] [Indexed: 01/10/2023]
Abstract
AIMS Increasing evidence suggests an association between diabetes and risk of venous thromboembolism (VTE); however, the results are inconsistent. We conducted a systematic review and meta-analysis of all epidemiological evidence to clarify association of diabetes with risk of VTE. METHODS We searched MEDLINE and EMBASE to retrieve all relevant articles. Pooled effect estimates were calculated through a random-effects model. RESULTS Sixteen articles involving 803,627,121 participants and 10,429,227 VTE patients were included. Pooled analysis of all evidence suggested that diabetes was associated with increased risk of VTE (HR, 1.35; 95%CI, 1.17-1.55; p=2.92*10(-5)), with evidence of small-study effect (p=0.024) and heterogeneity (I(2)=87.1%, p<0.001). However, when analysis was restricted to high quality cohort studies, the association remained significantly (HR, 1.36; 95%CI 1.11-1.68; p=0.004), with no evidence of publication bias (p=0.192) and heterogeneity (I(2)=23.2%, p=0.245). CONCLUSIONS Diabetes is associated with increased risk of VTE, which may have implications for the primary and secondary prevention of VTE.
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Affiliation(s)
- Jing Bai
- Department of Cardiology of PLA 161 Hospital, Wuhan 430030, China
| | - Xiang Ding
- Department of Cardiology of PLA 161 Hospital, Wuhan 430030, China
| | - Xiaohui Du
- Department of Cardiology of PLA 161 Hospital, Wuhan 430030, China
| | - Xiangfeng Zhao
- Department of Cardiology of PLA 161 Hospital, Wuhan 430030, China
| | - Zhiquan Wang
- Department of Cardiology of PLA 161 Hospital, Wuhan 430030, China.
| | - Zhiqiang Ma
- Department of Cardiology of PLA 161 Hospital, Wuhan 430030, China.
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10
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Lind C, Enga KF, Mathiesen EB, Njølstad I, Brækkan SK, Hansen JB. Family History of Myocardial Infarction and Cause-Specific Risk of Myocardial Infarction and Venous Thromboembolism. ACTA ACUST UNITED AC 2014; 7:684-91. [DOI: 10.1161/circgenetics.114.000621] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
A family history of myocardial infarction (FHMI) has been shown to increase the risk of venous thromboembolism (VTE). The mechanism underlying the association remains unclear. Therefore, we aimed to determine the risks of MI and VTE by FHMI using a cause-specific model and to explore whether atherosclerotic risk factors could explain the association between FHMI and VTE in a population-based cohort.
Methods and Results—
The study included 21 624 subjects recruited from the Tromsø Study in 1994 to 1995 and 2001 to 2002. Incident MI and VTE events were registered from date of enrollment to end of follow-up, December 31, 2010. There were 1311 MIs and 428 VTEs during a median follow-up of 15.8 years. FHMI was associated with a 52% increased risk of MI (adjusted hazard ratio, 1.52; 95% confidence interval, 1.35–1.70) and a 26% increased risk of VTE (adjusted hazard ratio, 1.26; 95% confidence interval, 1.02–1.55) in the cause-specific Cox model. Similar results were found using the traditional Cox model. The risk estimates by status of FHMI were highest for unprovoked deep vein thrombosis (adjusted hazard ratio, 1.69; 95% confidence interval, 1.12–2.56), and the risk increased with increasing number of affected relatives. Modifiable atherosclerotic risk factors slightly altered the association between FHMI and MI but had a negligible effect on the association between FHMI and VTE.
Conclusions—
FHMI was associated with increased risk of both MI and VTE in a cause-specific model. Apparently, the association between FHMI and VTE applied to unprovoked deep vein thrombosis and was not explained by modifiable atherosclerotic risk factors.
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Affiliation(s)
- Caroline Lind
- From the Department of Clinical Medicine, K.G. Jebsen Thrombosis Research and Expertise Center (TREC) (C.L., K.F.E., E.B.M., I.N., S.K.B., J.-B.H.), Department of Clinical Medicine, Hematological Research Group (C.L., K.F.E., S.K.B., J.-B.H.), Brain and Circulation Research Group, Department of Clinical Medicine (E.B.M.), Epidemiology of Chronic Diseases Research Group, Department of Community Medicine (I.N.), University of Tromsø, Tromsø, Norway; Department of Neurology and Clinical Neurophysiology
| | - Kristin F. Enga
- From the Department of Clinical Medicine, K.G. Jebsen Thrombosis Research and Expertise Center (TREC) (C.L., K.F.E., E.B.M., I.N., S.K.B., J.-B.H.), Department of Clinical Medicine, Hematological Research Group (C.L., K.F.E., S.K.B., J.-B.H.), Brain and Circulation Research Group, Department of Clinical Medicine (E.B.M.), Epidemiology of Chronic Diseases Research Group, Department of Community Medicine (I.N.), University of Tromsø, Tromsø, Norway; Department of Neurology and Clinical Neurophysiology
| | - Ellisiv B. Mathiesen
- From the Department of Clinical Medicine, K.G. Jebsen Thrombosis Research and Expertise Center (TREC) (C.L., K.F.E., E.B.M., I.N., S.K.B., J.-B.H.), Department of Clinical Medicine, Hematological Research Group (C.L., K.F.E., S.K.B., J.-B.H.), Brain and Circulation Research Group, Department of Clinical Medicine (E.B.M.), Epidemiology of Chronic Diseases Research Group, Department of Community Medicine (I.N.), University of Tromsø, Tromsø, Norway; Department of Neurology and Clinical Neurophysiology
| | - Inger Njølstad
- From the Department of Clinical Medicine, K.G. Jebsen Thrombosis Research and Expertise Center (TREC) (C.L., K.F.E., E.B.M., I.N., S.K.B., J.-B.H.), Department of Clinical Medicine, Hematological Research Group (C.L., K.F.E., S.K.B., J.-B.H.), Brain and Circulation Research Group, Department of Clinical Medicine (E.B.M.), Epidemiology of Chronic Diseases Research Group, Department of Community Medicine (I.N.), University of Tromsø, Tromsø, Norway; Department of Neurology and Clinical Neurophysiology
| | - Sigrid K. Brækkan
- From the Department of Clinical Medicine, K.G. Jebsen Thrombosis Research and Expertise Center (TREC) (C.L., K.F.E., E.B.M., I.N., S.K.B., J.-B.H.), Department of Clinical Medicine, Hematological Research Group (C.L., K.F.E., S.K.B., J.-B.H.), Brain and Circulation Research Group, Department of Clinical Medicine (E.B.M.), Epidemiology of Chronic Diseases Research Group, Department of Community Medicine (I.N.), University of Tromsø, Tromsø, Norway; Department of Neurology and Clinical Neurophysiology
| | - John-Bjarne Hansen
- From the Department of Clinical Medicine, K.G. Jebsen Thrombosis Research and Expertise Center (TREC) (C.L., K.F.E., E.B.M., I.N., S.K.B., J.-B.H.), Department of Clinical Medicine, Hematological Research Group (C.L., K.F.E., S.K.B., J.-B.H.), Brain and Circulation Research Group, Department of Clinical Medicine (E.B.M.), Epidemiology of Chronic Diseases Research Group, Department of Community Medicine (I.N.), University of Tromsø, Tromsø, Norway; Department of Neurology and Clinical Neurophysiology
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