Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Coagulation Unit, Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.
J Thromb Haemost. 2021 Feb;19(2):460-469. doi: 10.1111/jth.15168. Epub 2020 Dec 8.
Abdominal obesity has been shown to be a superior measure over overall obesity for detecting cardiovascular risk.
We conducted this study to compare the effects of overall and abdominal obesity on venous thromboembolism (VTE) and to calculate population attributable fraction for obesity for VTE.
Body mass index (BMI) and waist circumference (WC) were used to represent overall and abdominal obesity, respectively. In the cohort study, we included 74317 Swedish adults with anthropometric measures in 1997 and of whom 4332 were diagnosed with VTE until the end of 2017. A Mendelian randomization study was conducted to investigate causal associations of BMI, WC, and WC adjusted for BMI with VTE using data from FinnGen and UK Biobank study. Population attributable fraction was calculated for overall and abdominal obesity for VTE.
In the cohort study, there were dose-response associations of BMI and WC with VTE. The association between BMI and VTE was attenuated largely after adjusting for WC. Among individuals with normal BMI, participants with substantially increased WC had 53% higher (hazard ratio 1.53; 95% confidence interval, 1.28, 1.81) risk of VTE compared to those with normal WC. The causality of the association of WC adjusted for BMI with VTE was confirmed in Mendelian randomization analysis. The estimated population-attributable risk due to elevated BMI and WC were 12.4% (8.4%, 16.5%) and 23.7% (18.1%, 29.4%), respectively.
WC might be a preferable indicator linking obesity to VTE. A large proportion of VTE cases can be prevented if the population maintained a healthy BMI and WC.
腹部肥胖在检测心血管风险方面已被证明优于整体肥胖。
我们进行这项研究是为了比较整体肥胖和腹部肥胖对静脉血栓栓塞（VTE）的影响，并计算肥胖对 VTE 的人群归因分数。
使用体重指数（BMI）和腰围（WC）分别代表整体肥胖和腹部肥胖。在队列研究中，我们纳入了 74317 名瑞典成年人，他们在 1997 年进行了人体测量，并在 2017 年底前有 4332 人被诊断为 VTE。我们进行了一项孟德尔随机化研究，使用 FinnGen 和 UK Biobank 研究的数据，调查 BMI、WC 和调整 BMI 的 WC 与 VTE 之间的因果关系。计算了肥胖对 VTE 的总人群归因分数和腹部肥胖归因分数。
在队列研究中，BMI 和 WC 与 VTE 呈剂量反应关系。在调整 WC 后，BMI 与 VTE 的关联大大减弱。在 BMI 正常的人群中，与 WC 正常的参与者相比，WC 显著增加的参与者 VTE 风险增加了 53%（风险比 1.53；95%置信区间，1.28，1.81）。在 Mendelian 随机化分析中，证实了调整 BMI 后的 WC 与 VTE 之间的关联具有因果关系。由于 BMI 和 WC 升高而导致的估计人群归因风险分别为 12.4%（8.4%，16.5%）和 23.7%（18.1%，29.4%）。
WC 可能是肥胖与 VTE 之间的一个更优指标。如果人群保持健康的 BMI 和 WC，就可以预防很大一部分 VTE 病例。
