Cardiovascular Mortality after Venous Thromboembolism: A Meta-Analysis of Prospective Cohort Studies

Abstract

Many studies from current literature show that cardiovascular diseases in patients with venous thromboembolism (VTE) are more frequent than in the general population without VTE. However, data summarizing the impact of cardiovascular diseases on mortality of patients with VTE are lacking. In this systematic review and meta-analysis, we aimed to determine the frequency and incidence rate of cardiovascular death in patients with VTE. MEDLINE and EMBASE were searched from January 1, 2000 to February 28, 2021. Eligible studies were observational prospective cohort studies including patients with VTE and reporting all causes of death. Cardiovascular death was defined as deaths that result from new or recurrent pulmonary embolism, death due to acute myocardial infarction, sudden cardiac death or heart failure, death due to stroke, death due to cardiovascular procedures or hemorrhage, death due to ruptured aortic aneurysm or aortic dissection and death due to other cardiovascular causes. Random-effect models meta-analysis served to determine all pooled effect size of interest with their 95% confidence interval (CI). Thirteen observational studies enrolling 22,251 patients were identified and included. The mean/median age varied between 49 and 75 years. The proportion of men ranged from 38.3 to 53.2%. The overall pooled frequency of cardiovascular death in patients with VTE was 3.9% (95% CI: 2.5–5.6%), while the overall pooled frequency of all-cause mortality was 12.0% (95% CI: 9.1–15.4%). The pooled proportion of cardiovascular death among all causes of deaths in patients with VTE was 35.2% (95% CI: 22.2–49.3%). The pooled incidence rate of cardiovascular death was 1.92 per 100 patient-years (95% CI: 0–4.1). The frequency of cardiovascular death in patients with VTE was significantly higher than in patients without VTE (risk ratio: 3.85, 95% CI: 2.75–5.39). Based on this updated meta-analysis from 13 prospective cohort studies, cardiovascular death in patients with VTE is more frequent than in the general population without VTE.

Atrial Fibrillation as a Prognostic Indicator in Patients With Orthostatic Hypotension: Nationwide Inpatient Sample Analysis

“…Similarly, pooled data from the prospective Cardiovascular Health Study (CHS) and the Atherosclerosis Risk in Communities (ARIC) Study show a moderately increased risk of VTE in older adults with OH [55], while thromboembolic complications in AF patients have been extensively reported by Rubart et al [56]. A recent meta-analysis by Noumegni et al shows that over 35% of deaths among VTE patients were attributable to cardiovascular deaths [57].…”

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“…Noumegni et al also performed a meta-analysis of 13 studies to evaluate the risk of cardiovascular death after VTE. 14 The follow-up varied between 1 and 60 months in the studies. Approximately one-third of the recorded deaths was classified as cardiovascular, which was higher than in a population that had not had VTE.…”

Risk Factors of Cardiovascular Death after Venous Thromboembolism: Results from a Prospective Cohort Study

“…9 Moreover, the authors were able to compare frequency of CVDT in patients with VTE and in controls without VTE in two studies and they found a pooled risk ratio of 3.85, which was statistically significant. 9 10 11…”

“…9 Moreover, the authors were able to compare frequency of CVDT in patients with VTE and in controls without VTE in two studies and they found a pooled risk ratio of 3.85, which was statistically significant. [9][10][11] In the goal to reduce the incidence of arterial cardiovascular events and the incidence of recurrent VTE, which are the most frequent causes of CVDTs in patients with VTE, several studies explored the risk factors of these events in patients with VTE. [12][13][14][15][16][17] Despite the fact that the great majority of these studies did not consider the impact of non-CVDT as potential competing events to their outcome of interest, they allowed a considerable progress in the prevention of all cardiovascular events after VTE.…”

“…[5][6][7][8][9] In the most recent meta-analysis by Noumegni et al that included 13 cohort studies and aimed to explore the frequency and incidence of CVDT in patients with VTE compared with the general population, the authors found a pooled proportion of CVDT among all causes of deaths of 35.2% in patients with VTE. 9 Moreover, the authors were able to compare frequency of CVDT in patients with VTE and in controls without VTE in two studies and they found a pooled risk ratio of 3.85, which was statistically significant. [9][10][11] In the goal to reduce the incidence of arterial cardiovascular events and the incidence of recurrent VTE, which are the most frequent causes of CVDTs in patients with VTE, several studies explored the risk factors of these events in patients with VTE.…”