Higher VTE Risk Associated Most With Older Age, Smoking, and Adiposity

Lung Pulmonary Artery Thrombosis
Lung Pulmonary Artery Thrombosis
Investigators examined a link between major cardiovascular risk factors, such as older age and smoking, and venous thromboembolism, consisting of deep vein thrombosis or pulmonary embolism.

Of several established cardiovascular (CV) risk factors, older age, smoking, and adiposity were most consistently associated with higher risk for venous thromboembolism (VTE), according to study results recently published in JAMA Cardiology.

Researchers aimed to investigate associations of several established CV risk factors with the incidence of VTE outcomes by analyzing data from <1.1 million participants in 76 prospective studies from the Emerging Risk Factors Collaboration (ERFC) and the UK Biobank. Eligibility depended on having recorded information of established CV risk factors, no known baseline history of CV disease, and ≥1 year of follow-up data available after baseline.

Participant data from 75 ERFC cohorts (n=731,728) and the UK Biobank (n=421,537) showed that associations of several CV risk factors with VTE were approximately log-linear. In ERFC, older age had an approximately 2.8-fold higher risk per decade, and there was a 1.8-fold higher risk per decade in UK Biobank. Current smoking status was associated with higher risk in ERFC (hazard ratio [HR] 1.38; 95% CI: 1.2-1.58) and to a lesser extent in UK Biobank (HR 1.23; 95% CI: 1.08-1.4).

Markers of adiposity were positively associated with higher VTE risk (eg, HR per 1-standard deviation higher body mass index was 1.43 (95% CI, 1.35-1.5) in ERFC and was 1.37 (95% CI: 1.32-1.41) in UK Biobank.

There were several inconsistent associations of blood pressure and diabetes history with VTE outcomes in the samples analyzed. For example, 1-standard deviation higher systolic blood pressure was not associated with risk for VTE in ERFC (HR 1.07; 95% CI: 0.95-1.19) but was inversely associated with risk for VTE in UK Biobank (HR 0.83; 95% CI: 0.77-0.9).

This study was limited by potential misclassifications of disease outcomes from inaccuracies in discharge records and death certificates, and the inability to have consistent information in ERFC data on non-CV disease risk factors. Future studies would benefit from having access to more detailed clinical information.

The authors conclude that their findings “suggest that there is overlap in at least some major population determinants of important venous and arterial thrombotic diseases.”

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Multiple authors declare affiliations with the pharmaceutical industry. Please refer to original reference for a full list of authors’ disclosures.


Gregson J, Kaptoge S, Bolton T, et al. Cardiovascular risk factors associated with venous thromboembolism [published online January 16, 2019]. JAMA Cardiol. doi: 10.1001/jamacardio.2018.4537