Chang Wei-Ting, Chang Chia-Li, Ho Chung-Han, Hong Chon-Seng, Wang Jhi-Joung, Chen Zhih-Cherng
Department of Cardiology, Chi Mei Medical Center, Tainan, Taiwan.
Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
J Am Heart Assoc. 2017 May 3;6(5):e005466. doi: 10.1161/JAHA.117.005466.
Patients with unprovoked venous thromboembolism (VTE) are at an increased risk of mortality, but whether their cardiovascular risks also increase remains to be determined. We aimed to investigate the factors associated with overall mortality and major adverse cardiovascular events in patients with unprovoked VTE.
We identified 2154 patients newly diagnosed with unprovoked VTE from Taiwan's National Health Insurance Database between 2000 and 2013, excluding those with reversible etiologies, underlying cancer, or autoimmune diseases. These patients with VTE were compared with an age-, sex-, and cardiovascular risk-matched cohort of 4308 controls. The risk of mortality and major adverse cardiovascular events in patients with VTE was 2.23 (CI, 1.93-2.57; <0.0001) and 1.86 (CI, 1.65-2.09; <0.0001) times, respectively, higher than that of the conditions in controls. These events mostly occurred during the first year after the diagnosis of unprovoked VTE. Among patients with VTE, advanced age, male sex, and comorbid diabetes mellitus indicated a higher incidence of mortality and major adverse cardiovascular events. Conversely, comorbid hyperlipidemia attenuated these risks.
This nation-wide cohort study revealed that patients with unprovoked VTE, particularly older males with diabetes mellitus, had an elevated risk of both mortality and cardiovascular events. Risk of mortality and major adverse cardiovascular events were highest within the first year after diagnosis and persisted during the 10 years of follow-up.
不明原因静脉血栓栓塞症（VTE）患者的死亡风险增加，但其心血管风险是否也会增加仍有待确定。我们旨在研究不明原因VTE患者全因死亡率和主要不良心血管事件的相关因素。
我们从台湾国民健康保险数据库中识别出2000年至2013年间新诊断为不明原因VTE的2154例患者，排除那些有可逆病因、潜在癌症或自身免疫性疾病的患者。将这些VTE患者与4308例年龄、性别和心血管风险匹配的对照组进行比较。VTE患者的死亡风险和主要不良心血管事件风险分别是对照组的2.23倍（CI，1.93 - 2.57；<0.0001）和1.86倍（CI，1.65 - 2.09；<0.0001）。这些事件大多发生在不明原因VTE诊断后的第一年。在VTE患者中，高龄、男性和合并糖尿病表明死亡和主要不良心血管事件的发生率较高。相反，合并高脂血症可降低这些风险。
这项全国性队列研究表明，不明原因VTE患者，尤其是患有糖尿病的老年男性，死亡和心血管事件风险均升高。死亡风险和主要不良心血管事件风险在诊断后的第一年内最高，并在10年随访期间持续存在。
