Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Blood. 2013 Jun 13;121(24):4948-54. doi: 10.1182/blood-2013-01-479238. Epub 2013 May 3.
Patients with venous thrombosis (VT) have an increased risk of subsequent CVD (CVD), but the underlying pathophysiology is unclear. Using data from the Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis follow-up study, 4480 patients with VT, 2926 partner control participants, and 2638 random digit dialing (RDD) control participants were followed-up between 1999 and 2008. Incidence rates and hazard ratios with 95% confidence intervals (95% CIs) of CVD (defined as myocardial infarction or ischemic stroke) were calculated for patients vs controls. Measurable confounders (age, sex, body mass index, smoking, chronic disease, malignancy, genetic thrombophilia, and procoagulant markers) were adjusted for when comparing patients with RDD controls. Unmeasured lifestyle-related factors were also considered by comparing patients with their partners. During a median follow-up time of 5 years, 124 CVD events occurred. Incidence of CVD per 1000 person-years was 3.2 (95% CI, 2.5-4.0) in patients, 2.2 (95% CI, 1.5-3.0) in partners, and 1.6 (95% CI, 0.9-2.6) in RDD controls. Crude hazard ratio was 2.2 (95% CI, 1.2-3.8) in patients compared with RDD controls and 1.5 (95% CI, 1.0-2.3) in patients compared with partners. After adjustment for all confounders, these risks attenuated to 1.8 (95% CI, 0.8-4.2) and 1.3 (95% CI, 0.7-2.5) for patients compared with RDD control participants and partners, respectively. In conclusion, individuals with VT had an increased risk of CVD. This could be explained by common etiologic factors.
静脉血栓形成(VT)患者发生随后心血管疾病(CVD)的风险增加,但潜在的病理生理学机制尚不清楚。利用来自多环境和基因评估静脉血栓形成危险因素随访研究的数据,1999 年至 2008 年间对 4480 例 VT 患者、2926 名对照参与者和 2638 名随机数字拨号(RDD)对照参与者进行了随访。计算了患者与对照组相比 CVD(定义为心肌梗死或缺血性中风)的发生率和风险比(95%置信区间[95%CI])。在比较患者与 RDD 对照组时,调整了可测量的混杂因素(年龄、性别、体重指数、吸烟、慢性疾病、恶性肿瘤、遗传性血栓形成倾向和促凝标志物)。通过比较患者与其伴侣,还考虑了未测量的与生活方式相关的因素。在中位数为 5 年的随访期间,发生了 124 例 CVD 事件。每 1000 人年 CVD 发生率为 3.2(95%CI,2.5-4.0)患者、2.2(95%CI,1.5-3.0)伴侣和 1.6(95%CI,0.9-2.6)RDD 对照组。与 RDD 对照组相比,患者的粗风险比为 2.2(95%CI,1.2-3.8),与伴侣相比为 1.5(95%CI,1.0-2.3)。调整所有混杂因素后,与 RDD 对照组相比,患者的风险分别减弱至 1.8(95%CI,0.8-4.2)和 1.3(95%CI,0.7-2.5),与伴侣相比。总之,VT 患者 CVD 的风险增加。这可以用共同的病因因素来解释。