Association Between the Metabolic Syndrome, Its Individual Components, and Unprovoked Venous Thromboembolism

Abstract

Objective The metabolic syndrome (MetS) may contribute to the pathogenesis of venous thromboembolism (VTE), but this association requires additional investigation. Approach and Results We performed a patient-level meta-analysis of case-control and cohort studies that evaluated the role of MetS and risk of unprovoked VTE. For case-control studies, odds ratios (ORs) and 95% confidence intervals (CI) were calculated using logistic regression analysis to estimate the influence of individual variables on the risk of VTE; Chi squared tests for trend were used to investigate the impact of increasing number of components of MetS on the risk of VTE, and to explore the influence of abdominal obesity on this relationship. For cohort studies, hazard ratios (HRs) and 95% CI were calculated by using multivariable Cox regression analysis. Six case-control studies were included (908 cases with unprovoked VTE and 1794 controls): in multivariate analysis, MetS was independently associated with VTE (OR 1.91, 95% 1.57-2.33) and both MetS and abdominal obesity were better predictors of unprovoked VTE than obesity defined by the body mass index (BMI). Two prospective cohort studies were included (26.531 subjects, 289 unprovoked VTE events): age, obesity, and abdominal obesity, but not MetS were associated with VTE. Conclusions Case-control, but not prospective cohort studies support an association between MetS and VTE. Abdominal adiposity is a strong risk factor for VTE.

Visceral obesity, but not metabolic syndrome, is associated with the presence of post-thrombotic syndrome

“…We deepened earlier data by showing that the increase in waist circumference is the only determinant of MetS showing significant correlation with PTS. This observation is coherent with data from perspective studies showing that visceral adiposity is the only component of MetS harboring independent predictive value of future VTE risk [11,12]. Of note, when we performed a correlation analysis on the whole population we found a significant association between the measure of waist circumference and the VS value.…”

“…However, this correlation was not confirmed by prospective investigations, which instead identified visceral obesity as the only feature of MetS predictive of future VTE [11,12].…”

Venous and Arterial Thrombosis: Is there a Link?

“…According to the results of subsequent population-based study, abdominal obesity appears to be the pivotal risk factor among the individual components of the metabolic syndrome [13][14][15] . While the review by Ageno et al failed to identify smoking as an additional potential risk factor for VTE, the findings from two more recent population-based studies provided strong evidence that this is the case [16,17] .…”

Insufficient Lymph Drainage Causes Abnormal Lipid Accumulation and Vein Wall Degeneration

“…The pathophysiological mechanisms responsible for VV and deep vein thrombosis involve lipid metabolism abnormalities. 19,20) Previously, we analyzed VV from patients with chronic venous insufficiency using IMS and detected the abnormal accumulation of lipid molecules in the walls of the VV, possibly due to insufficient lipid drainage by the lymphatic vessels. 19) Furthermore, we found that there are lymph vessels in the great saphenous vein wall, but the number of lymph vessels in the great saphenous vein wall was lower in the VV patients with prominent cutaneous symptoms.…”