Mi Yuhong, Yan Shufeng, Lu Yanhui, Liang Ying, Li Chunsheng
Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Disease, Beijing, China Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Medicine (Baltimore). 2016 Aug;95(32):e4495. doi: 10.1097/MD.0000000000004495.
Previous studies have shown that idiopathic pulmonary embolism is positively associated with other cardiovascular events, such as myocardial infarction and stroke, suggesting a potentially important association between atherosclerosis risk factors and venous thromboembolism (VTE). We performed a meta-analysis to evaluate the correlation between risk factors for atherosclerosis and VTE.
In December 2014, we searched MEDLINE and EMBASE for studies evaluating the associations between VTE and risk factors for atherosclerosis and pooled outcome data using random-effects meta-analysis. In addition, we analyzed publication bias.
Thirty-three case-control and cohort studies with a total of 185,124 patients met the inclusion criteria. We found that participants with body mass index (BMI) ≥30 kg/m had a significantly higher prevalence of VTE than those with BMI <30 kg/m in both case-control studies (odds ratio [OR] = 2.45, 95% confidence interval [CI]: 1.78-3.35) and cohort studies (relative risk [RR] = 2.39, 95% CI: 1.79-3.17). VTE was more prevalent in patients with hypertension than without hypertension (OR = 1.40, 95% CI: 1.06-1.84; RR = 1.36, 95% CI: 1.11-1.67). The findings were similar for VTE prevalence between patients with and without diabetes (OR = 1.78, 95% CI: 1.17-2.69; RR = 1.41, 95% CI: 1.20-1.66). Current smoking was significantly associated with VTE prevalence in case-control studies (OR = 1.34, 95% CI: 1.01-1.77), but not in cohort studies (RR = 1.29, 95% CI: 0.96-1.72). In addition, we found that total cholesterol and triglyceride concentrations were significantly higher in patients with VTE than without VTE (weighted mean differences [WMD] = 8.94 mg/dL, 95% CI: 3.52-14.35 mg/dL, and WMD = 14.00 mg/dL, 95% CI: 8.85-19.16 mg/dL, respectively). High-density lipoprotein cholesterol concentrations were significantly lower in patients with VTE than without VTE (WMD = -2.03 mg/dL, 95% CI: -3.42 to -0.63 mg/dL). Higher quality studies were more homogeneous, but confirmed the same significant associations.
Based on our systematic review and meta-analysis, we observed a significant association between VTE and the risk factors for atherosclerosis. These results may make an important contribution to clinical practice regarding VTE treatment.
既往研究表明，特发性肺栓塞与其他心血管事件（如心肌梗死和中风）呈正相关，提示动脉粥样硬化危险因素与静脉血栓栓塞症（VTE）之间可能存在重要关联。我们进行了一项荟萃分析，以评估动脉粥样硬化危险因素与VTE之间的相关性。
2014年12月，我们检索了MEDLINE和EMBASE，查找评估VTE与动脉粥样硬化危险因素之间关联的研究，并使用随机效应荟萃分析汇总结局数据。此外，我们分析了发表偏倚。
33项病例对照研究和队列研究，共纳入185124例患者，符合纳入标准。我们发现，在病例对照研究（比值比[OR]=2.45，95%置信区间[CI]：1.78-3.35）和队列研究（相对危险度[RR]=2.39，95%CI：1.79-3.17）中，体重指数（BMI）≥30kg/m²的参与者VTE患病率显著高于BMI<30kg/m²的参与者。高血压患者的VTE患病率高于无高血压患者（OR=1.40，95%CI：1.06-1.84；RR=1.36，95%CI：1.11-1.67）。糖尿病患者与非糖尿病患者的VTE患病率情况相似（OR=1.78，95%CI：1.17-2.69；RR=1.41，95%CI：1.20-1.66）。在病例对照研究中，当前吸烟与VTE患病率显著相关（OR=1.34，95%CI：1.01-1.77），但在队列研究中无此关联（RR=1.29，95%CI：0.96-1.72）。此外，我们发现VTE患者的总胆固醇和甘油三酯浓度显著高于无VTE患者（加权平均差[WMD]=8.94mg/dL，95%CI：3.52-14.35mg/dL，以及WMD=14.00mg/dL，95%CI：8.85-19.16mg/dL）。VTE患者的高密度脂蛋白胆固醇浓度显著低于无VTE患者（WMD=-2.03mg/dL，95%CI：-3.42至-0.63mg/dL）。质量较高的研究同质性更强，但证实了相同的显著关联。
基于我们的系统评价和荟萃分析，我们观察到VTE与动脉粥样硬化危险因素之间存在显著关联。这些结果可能对VTE治疗的临床实践做出重要贡献。
