London School of Hygiene and Tropical Medicine, London, United Kingdom.
MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
JAMA Cardiol. 2019 Feb 1;4(2):163-173. doi: 10.1001/jamacardio.2018.4537.
It is uncertain to what extent established cardiovascular risk factors are associated with venous thromboembolism (VTE).
To estimate the associations of major cardiovascular risk factors with VTE, ie, deep vein thrombosis and pulmonary embolism.
DESIGN, SETTING, AND PARTICIPANTS: This study included individual participant data mostly from essentially population-based cohort studies from the Emerging Risk Factors Collaboration (ERFC; 731 728 participants; 75 cohorts; years of baseline surveys, February 1960 to June 2008; latest date of follow-up, December 2015) and the UK Biobank (421 537 participants; years of baseline surveys, March 2006 to September 2010; latest date of follow-up, February 2016). Participants without cardiovascular disease at baseline were included. Data were analyzed from June 2017 to September 2018.
A panel of several established cardiovascular risk factors.
Hazard ratios (HRs) per 1-SD higher usual risk factor levels (or presence/absence). Incident fatal outcomes in ERFC (VTE, 1041; coronary heart disease [CHD], 25 131) and incident fatal/nonfatal outcomes in UK Biobank (VTE, 2321; CHD, 3385). Hazard ratios were adjusted for age, sex, smoking status, diabetes, and body mass index (BMI).
Of the 731 728 participants from the ERFC, 403 396 (55.1%) were female, and the mean (SD) age at the time of the survey was 51.9 (9.0) years; of the 421 537 participants from the UK Biobank, 233 699 (55.4%) were female, and the mean (SD) age at the time of the survey was 56.4 (8.1) years. Risk factors for VTE included older age (ERFC: HR per decade, 2.67; 95% CI, 2.45-2.91; UK Biobank: HR, 1.81; 95% CI, 1.71-1.92), current smoking (ERFC: HR, 1.38; 95% CI, 1.20-1.58; UK Biobank: HR, 1.23; 95% CI, 1.08-1.40), and BMI (ERFC: HR per 1-SD higher BMI, 1.43; 95% CI, 1.35-1.50; UK Biobank: HR, 1.37; 95% CI, 1.32-1.41). For these factors, there were similar HRs for pulmonary embolism and deep vein thrombosis in UK Biobank (except adiposity was more strongly associated with pulmonary embolism) and similar HRs for unprovoked vs provoked VTE. Apart from adiposity, these risk factors were less strongly associated with VTE than CHD. There were inconsistent associations of VTEs with diabetes and blood pressure across ERFC and UK Biobank, and there was limited ability to study lipid and inflammation markers.
Older age, smoking, and adiposity were consistently associated with higher VTE risk.
目前尚不确定既定心血管风险因素与静脉血栓栓塞症（VTE）有多大程度的关联。
评估主要心血管风险因素与深静脉血栓形成和肺栓塞（VTE）的关联。
设计、地点和参与者：本研究纳入了主要来自基本人群队列研究的个体参与者数据，这些数据来自新兴风险因素协作组（ERFC；731728 名参与者；75 个队列；基线调查年份为 1960 年 2 月至 2008 年 6 月；最新随访日期为 2015 年 12 月）和英国生物银行（421537 名参与者；基线调查年份为 2006 年 3 月至 2010 年 9 月；最新随访日期为 2016 年 2 月）。纳入的参与者均无心血管疾病。数据分析于 2017 年 6 月至 2018 年 9 月进行。
一组既定的心血管风险因素。
每个惯用风险因素水平升高 1 个标准差的风险比（HR）（或存在/缺失）。ERFC 中发生的致命结局（VTE，1041 例；冠心病[CHD]，25131 例）和 UK Biobank 中发生的致命/非致命结局（VTE，2321 例；CHD，3385 例）。HR 经过年龄、性别、吸烟状况、糖尿病和体重指数（BMI）的调整。
在 ERFC 的 731728 名参与者中，403396 名（55.1%）为女性，调查时的平均（SD）年龄为 51.9（9.0）岁；在 UK Biobank 的 421537 名参与者中，233699 名（55.4%）为女性，调查时的平均（SD）年龄为 56.4（8.1）岁。VTE 的风险因素包括年龄较大（ERFC：每十年 HR，2.67；95%CI，2.45-2.91；UK Biobank：HR，1.81；95%CI，1.71-1.92）、当前吸烟（ERFC：HR，1.38；95%CI，1.20-1.58；UK Biobank：HR，1.23；95%CI，1.08-1.40）和 BMI（ERFC：每 1-SD 更高 BMI HR，1.43；95%CI，1.35-1.50；UK Biobank：HR，1.37；95%CI，1.32-1.41）。对于这些因素，在 UK Biobank 中，肺栓塞和深静脉血栓形成的 HR 相似（除肥胖与肺栓塞的关联更强外），且无诱因与有诱因 VTE 的 HR 相似。除肥胖外，这些风险因素与 CHD 相比，与 VTE 的关联较弱。在 ERFC 和 UK Biobank 中，VTE 与糖尿病和血压的关联不一致，且研究血脂和炎症标志物的能力有限。
年龄较大、吸烟和肥胖与更高的 VTE 风险始终相关。
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