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The Longitudinal Investigation of Thromboembolism Etiology

Albert W. Tsai, PhD; Mary Cushman, MD; Wayne D. Rosamond, PhD; Susan R. Heckbert, MD, PhD; Joseph F. Polak, MD, MPH; Aaron R. Folsom, MD

Arch Intern Med. 2002;162:1182-1189.

Background  The association between traditional cardiovascular risk factors and risk of venous thromboembolism (VTE) has not been extensively examined in prospective studies.

Methods  To determine whether atherosclerotic risk factors are also associated with increased incidence of VTE, we conducted a prospective study of 19 293 men and women without previous VTE in 6 US communities between 1987 and 1998.

Results  There were 215 validated VTE events (1.45 per 1000 person-years) during a median of 8 years of follow-up. The age-adjusted hazard ratio was 1.4 (95% confidence interval [CI], 1.1-1.9) for men vs women, 1.6 (95% CI, 1.2-2.2) for blacks vs whites, and 1.7 (95% CI, 1.5-2.0) per decade of age. Cigarette smoking, hypertension, dyslipidemia, physical inactivity, and alcohol consumption were not associated with risk of VTE. Age-, race-, and sex-adjusted hazard ratios for body mass index categories (calculated as the weight in kilograms divided by the height in meters squared) of less than 25, 25 to less than 30, 30 to less than 35, 35 to less than 40, and 40 or more were 1.0, 1.5, 2.2, 1.5, and 2.7, respectively (P<.001 for the trend). Diabetes was also associated with an increased risk of VTE (adjusted hazard ratio, 1.5 [95% CI, 1.0-2.1]).

Conclusions  Our data showing no relationship of some arterial risk factors with VTE corroborate the view that the etiology of VTE differs from atherosclerotic cardiovascular disease. In addition, the findings suggest a hypothesis that avoidance of obesity and diabetes or vigilance in prophylaxis in patients with those conditions may prevent some venous thromboses.

From the Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis (Drs Tsai and Folsom); Department of Medicine, Division of Hematology/Oncology, University of Vermont, Burlington (Dr Cushman); Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill (Dr Rosamond); Department of Epidemiology, Cardiovascular Health Research Unit, University of Washington, Seattle (Dr Heckbert); and Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Mass (Dr Polak).

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