Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway.
J Thromb Haemost. 2022 Oct;20(10):2342-2349. doi: 10.1111/jth.15812. Epub 2022 Jul 19.
Myocardial infarction (MI) is associated with an increased risk of venous thromboembolism (VTE). Obesity is a recognized risk factor for both MI and VTE. Whether obesity further increases the risk of VTE in MI patients is scarcely investigated.
To study the joint effect of MI and obesity on the risk of VTE.
Study participants (n = 29 410) were recruited from three surveys of the Tromsø Study (conducted in 1994-1995, 2001, and 2007-2008) and followed up through 2014. All incident MI and VTE cases during follow-up were recorded. Cox regression models with MI as a time-dependent variable were used to estimate hazard ratios (HRs) of VTE (adjusted for age and sex) by combinations of MI exposure and obesity status. Joint effects were assessed by calculating relative excess risk and attributable proportion (AP) due to interaction.
During a median of 19.6 years of follow-up, 2090 study participants experienced an MI and 784 experienced a VTE. Among those with MI, 55 developed a subsequent VTE, yielding an overall incidence rate (IR) of VTE of 5.3 per 1000 person-years (95% confidence interval [CI]: 4.1-6.9). In the combined exposure group (MI+/Obesity+), the IR was 11.3 per 1000 person-years, and the adjusted HR indicated a 3-fold increased risk of VTE (HR 3.16, 95% CI: 1.99-4.99) compared to the reference group (MI-/Obesity-). The corresponding AP was 0.46 (95% CI: 0.17-0.74).
The combination of MI and obesity yielded a supra-additive effect on VTE risk of which 46% of the VTE events were attributed to the interaction.
心肌梗死（MI）与静脉血栓栓塞症（VTE）的风险增加相关。肥胖是 MI 和 VTE 的公认危险因素。肥胖是否会进一步增加 MI 患者 VTE 的风险，目前研究甚少。
研究 MI 和肥胖对 VTE 风险的联合影响。
研究参与者（n=29410）来自特罗姆瑟研究的三项调查（1994-1995 年、2001 年和 2007-2008 年），随访至 2014 年。随访期间所有新发 MI 和 VTE 病例均被记录。采用 Cox 回归模型，以 MI 为时间依赖性变量，根据 MI 暴露和肥胖状况的组合，估计 VTE 的危险比（HR）（调整年龄和性别）。通过计算相对超额风险和交互归因比例（AP）来评估联合效应。
在中位随访 19.6 年期间，2090 名研究参与者发生 MI，784 名参与者发生 VTE。在 MI 患者中，55 例患者随后发生 VTE，总体 VTE 发生率（IR）为 5.3/1000 人年（95%置信区间[CI]：4.1-6.9）。在联合暴露组（MI+/肥胖+）中，IR 为 11.3/1000 人年，调整后的 HR 表明 VTE 的风险增加 3 倍（HR 3.16，95%CI：1.99-4.99），与参考组（MI-/肥胖-）相比。相应的 AP 为 0.46（95%CI：0.17-0.74）。
MI 和肥胖的联合作用对 VTE 风险产生了超相加效应，其中 46%的 VTE 事件归因于相互作用。
