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(Circulation. 2007;115:1609-1614.)
© 2007 American Heart Association, Inc.

Vascular Medicine

High-Density Lipoprotein and the Risk of Recurrent Venous Thromboembolism

Sabine Eichinger, MD; Natalie M. Pecheniuk, PhD; Gregor Hron, MD; Hiroshi Deguchi, MD, PhD; Michael Schemper, PhD; Paul A. Kyrle, MD; John H. Griffin, PhD

From the Department of Internal Medicine I (S.E., G.H., P.A.K.) and the Core Unit for Medical Statistics and Informatics (M.S.), Medical University of Vienna, Vienna, Austria; and the Department of Molecular and Experimental Medicine (N.M.P., H.D., J.H.G.), The Scripps Research Institute, La Jolla, Calif.

Correspondence to John H. Griffin, PhD, Department of Molecular and Experimental Medicine (MEM-180), The Scripps Research Institute, 10550 N Torrey Pines Rd, La Jolla, CA 92037. E-mail jgriffin{at}scripps.edu

Received July 6, 2006; accepted January 5, 2007.

Background— High-density lipoprotein (HDL) protects against arterial atherothrombosis, but it is unknown whether it protects against recurrent venous thromboembolism.

Methods and Results— We studied 772 patients after a first spontaneous venous thromboembolism (average follow-up 48 months) and recorded the end point of symptomatic recurrent venous thromboembolism, which developed in 100 of the 772 patients. The relationship between plasma lipoprotein parameters and recurrence was evaluated. Plasma apolipoproteins AI and B were measured by immunoassays for all subjects. Compared with those without recurrence, patients with recurrence had lower mean (±SD) levels of apolipoprotein AI (1.12±0.22 versus 1.23±0.27 mg/mL, P<0.001) but similar apolipoprotein B levels. The relative risk of recurrence was 0.87 (95% CI, 0.80 to 0.94) for each increase of 0.1 mg/mL in plasma apolipoprotein AI. Compared with patients with apolipoprotein AI levels in the lowest tertile (<1.07 mg/mL), the relative risk of recurrence was 0.46 (95% CI, 0.27 to 0.77) for the highest-tertile patients (apolipoprotein AI >1.30 mg/mL) and 0.78 (95% CI, 0.50 to 1.22) for midtertile patients (apolipoprotein AI of 1.07 to 1.30 mg/mL). Using nuclear magnetic resonance, we determined the levels of 10 major lipoprotein subclasses and HDL cholesterol for 71 patients with recurrence and 142 matched patients without recurrence. We found a strong trend for association between recurrence and low levels of HDL particles and HDL cholesterol.

Conclusions— Patients with high levels of apolipoprotein AI and HDL have a decreased risk of recurrent venous thromboembolism.

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CLINICAL PERSPECTIVE

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