Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, Heidelberg, Germany.
Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care, Berlin, Germany.
Thromb Res. 2023 Jun;226:9-17. doi: 10.1016/j.thromres.2023.04.008. Epub 2023 Apr 13.
Venous thromboembolism (VTE) and arterial thromboembolism (ATE) are considered as two separate disease-entities. In recent years, studies have reported clear associations between VTE and atherosclerosis. We aimed to evaluate the long-term risk of ATE in VTE patients in comparison to controls without VTE.
Nationwide outpatient claims data of all inhabitants with statutory health insurance in Germany were used for secondary data analysis between the years 2011 and 2020. Patients treated in 2013 were stratified by VTE event, and groups were 1:2-matched by age and sex. The hazard for an ATE event in a 5-year follow-up period between patients with and without VTE was calculated with multivariable Cox regression adjusted for age, sex, cardiovascular risk factors, and comorbidities.
Of 69,699,277 individuals treated in the year 2013 by German physicians in outpatient care, in total 686,382 individuals (age 59.8 ± 17.5 years, 65.4 % females) were included comprising 228,794 patients with VTE and 457,588 controls without VTE. VTE patients more often had cardiovascular risk factors (81.6 % vs. 62.2 %) and traditional VTE risk factors. The occurrence of ATE events during follow-up was 1.8 %-points higher in VTE patients in comparison to the controls (9.7 % vs. 7.9 %). VTE events were independently associated with increased occurrence of ATE events within follow-up (HR 1.19 [99%CI 1.16-1.23], p < 0.0001).
Patients with a VTE event have an increased long-term risk for subsequent arterial cardiovascular events. Large prospective cohorts are needed to identify patient subgroups with a very high ATE risk after VTE.
静脉血栓栓塞症（VTE）和动脉血栓栓塞症（ATE）被认为是两种独立的疾病实体。近年来，研究报告了 VTE 与动脉粥样硬化之间的明确关联。我们旨在评估 VTE 患者与无 VTE 的对照组相比，ATE 的长期风险。
我们使用德国全民医保制度下的全国性门诊理赔数据进行了 2011 年至 2020 年的二次数据分析。2013 年接受治疗的患者根据 VTE 事件进行分层，并按年龄和性别 1:2 匹配。使用多变量 Cox 回归模型，根据年龄、性别、心血管危险因素和合并症，调整了 5 年随访期间 VTE 患者与无 VTE 患者发生 ATE 事件的风险比。
在 2013 年接受德国医生门诊治疗的 69699277 人中，共有 686382 人（年龄 59.8±17.5 岁，65.4%为女性）入组，包括 228794 例 VTE 患者和 457588 例对照组。VTE 患者更常伴有心血管危险因素（81.6% vs. 62.2%）和传统的 VTE 危险因素。在随访期间，VTE 患者发生 ATE 事件的比例比对照组高 1.8 个百分点（9.7% vs. 7.9%）。VTE 事件与随访期间 ATE 事件的发生独立相关（HR 1.19[99%CI 1.16-1.23]，p<0.0001）。
发生 VTE 事件的患者随后发生动脉心血管事件的长期风险增加。需要大型前瞻性队列研究来确定 VTE 后 ATE 风险非常高的患者亚组。
