Abstract P227: Diabetes Mellitus and Venous Thromboembolism: A Systematic Review and Meta-analysis
Introduction: Reported associations of diabetes with venous thromboembolism (VTE) are inconsistent. We conducted a systematic review and meta-analysis to quantify the association between diabetes mellitus (type 1 or 2) and VTE (deep vein thrombosis or pulmonary embolism).
Methods: A systematic review of observational studies was conducted using PubMed, Web of Science, and CINAHL through Dec 31, 2012. Additional studies were identified by contacting experts and through manual review of reference lists of review articles and articles eligible for the present study. We abstracted information on relative risk (RR) estimates and pooled these data using a random-effects model. We queried authors of papers that did not adjust for important confounders to request controlled RR estimates.
Results: We identified 10 studies (N participants: 240,940; 7 cohort, 3 case-control: Heit, Lidegaard, and Poulter) which provided RRs adjusted for age and BMI (Figure), and 8 additional studies which did not adjust for these confounders (N participants = 150,205). The pooled RR for the association of diabetes with VTE in the 10 studies was 1.18 (95% CI, 1.03-1.34). The test for heterogeneity was not significant (I2 = 23.8%, p = 0.22). Amongst the 10 studies, smaller studies tended to have lower RR estimates: Both the Begg and Egger tests were significant (p = 0.02 and 0.01, respectively). The other 8 studies showed evidence of significant between-study heterogeneity (I2 = 75.5%, p <0.0001), making a pooled estimate inappropriate.
Conclusions: Diabetes is associated with an 18% increased risk of VTE in observational studies after accounting for age and obesity. Possible explanations for the association of diabetes with VTE include increased hypercoagulability or vascular damage caused by the metabolic derangements of diabetes or increased exposure to VTE risk factors in individuals with diabetes. Further research is needed to elucidate the mechanisms of this association and whether improved control of diabetes is associated with reduced VTE risk.
Author Disclosures: E.J. Bell: None. A.R. Folsom: None. P.L. Lutsey: None. E. Selvin: None. M. Cushman: None. N.A. Zakai: None. A. Alonso: None.
- © 2014 by American Heart Association, Inc.