Published online before print December 17, 2007, doi: 10.1161/CIRCULATIONAHA.107.709204
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(Circulation. 2008;117:93-102.)
© 2008 American Heart Association, Inc.
Vascular Medicine |
Cardiovascular Risk Factors and Venous Thromboembolism
A Meta-Analysis
From the Department of Clinical Medicine, University of Insubria, Varese, Italy (W.A.); Department of Internal Medicine, University of Perugia, Italy (C.B.); SEALS, Prince of Wales Hospital, Sydney, Australia (T.B.); Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (R.S.); and Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands (P.W.K.).
Correspondence to Walter Ageno, U.O. Medicina I, Ospedale di Circolo, Viale Borri 57, 21100 Varese, Italy. E-mail agewal{at}yahoo.com
Received April 13, 2007; accepted October 12, 2007.
Background— The concept that venous thromboembolism (VTE) and atherosclerosis are 2 completely distinct entities has recently been challenged because patients with VTE have more asymptomatic atherosclerosis and more cardiovascular events than control subjects. We performed a meta-analysis to assess the association between cardiovascular risk factors and VTE.
Methods and Results— Medline and EMBASE databases were searched to identify studies that evaluated the prevalence of major cardiovascular risk factors in VTE patients and control subjects. Studies were selected using a priori defined criteria, and each study was reviewed by 2 authors who abstracted data on study characteristics, study quality, and outcomes. Odds ratios or weighted means and 95% confidence intervals (CIs) were then calculated and pooled using a random-effects model. Statistical heterogeneity was evaluated through the use of 
2 and I2 statistics. Twenty-one case-control and cohort studies with a total of 63 552 patients met the inclusion criteria. Compared with control subjects, the risk of VTE was 2.33 for obesity (95% CI, 1.68 to 3.24), 1.51 for hypertension (95% CI, 1.23 to 1.85), 1.42 for diabetes mellitus (95% CI, 1.12 to 1.77), 1.18 for smoking (95% CI, 0.95 to 1.46), and 1.16 for hypercholesterolemia (95% CI, 0.67 to 2.02). Weighted mean high-density lipoprotein cholesterol levels were significantly lower in VTE patients, whereas no difference was observed for total and low-density lipoprotein cholesterol levels. Significant heterogeneity among studies was present in all subgroups except for the diabetes mellitus subgroup. Higher-quality studies were more homogeneous, and significant associations remained unchanged.
Conclusions— Cardiovascular risk factors are associated with VTE. This association is clinically relevant with respect to individual screening, risk factor modification, and primary and secondary prevention of VTE. Prospective studies should further investigate the underlying mechanisms of this relationship.
CLINICAL PERSPECTIVE
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Clinical Summaries
Circulation 2008 117: 1-3.[Extract] [Full Text]
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