Lipid biomarkers, hormone therapy and the risk of venous thromboembolism in women

Abstract

To cite this article: Everett BM, Glynn RJ, Buring JE, Ridker PM. Lipid biomarkers, hormone therapy and the risk of venous thromboembolism in women. J Thromb Haemost 2009; 7: 588-96.Summary. Background: Published reports of a relationship between lipids and incident venous thromboembolism (VTE) are conflicting. Objectives: To clarify the relationship between lipids and VTE risk in healthy women, including potential effect modification by hormone therapy (HT). Patients/methods: Among 27 081 initially healthy women followed prospectively for incident VTE, we measured a full panel of lipid biomarkers, including total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides and apolipoproteins A-I (apo A-I) and B 100 . Results: During a median follow-up of 11.4 years, VTE occurred in 355 women. We observed no relationship between any of the lipids and VTE risk. However, when unprovoked VTE was considered separately (n = 161), both HDL-C and apo A-I were positively associated with risk. Fully adjusted hazard ratios (HR) and 95% confidence intervals (CI) for extreme tertiles of HDL-C and apo A-I were 1.75 (1.13-2.73) and 1.70 (1.10-2.62), respectively. After stratifying by HT use, this relationship was present only among HT users; the HRs for unprovoked VTE for extreme tertiles of HDL-C and apo A-I were 3.58 (1.69-7.58) and 2.88 (1.29-6.42) among users, but only 0.79 (0.39-1.62) and 0.89 (0.50-1.57) among non-users. The interactions were statistically significant (each P interaction <0.05). Conclusions: We observed little evidence that lipid levels predict risk of incident VTE among non-users of HT. High levels of HDL-C and apo A-I associate with unprovoked VTE risk among HT users. This observation likely reflects prothrombotic effects of HT that are concomitant with HDL-C and apo A-I levels, rather than direct effects of those lipids.

Physical inactivity and idiopathic pulmonary embolism in women: prospective study

“…[5][6][7][8][9][10][11][12] In our analysis we found no significant association between physical activity (metabolic equivalents/week) and the risk of idiopathic pulmonary embolism. In addition, the increased risk of pulmonary embolism associated with physical inactivity was more apparent in women with lower levels of physical activity.…”

“…Arterial and venous thrombosis share multiple risk factors such as obesity, cigarette smoking, and hypertension. [4][5][6][7] Associations between physical inactivity, physical activity, and pulmonary embolism remain uncertain. Some published case-control studies found that exercising on a regular basis decreases the risk of venous thrombosis by 30-50% compared with not exercising.…”

“…[8][9][10] Other studies, however, including prospective cohort studies, have found that physical activity is associated with an increased risk of venous thromboembolism. [5][6][7][8][9][10][11][12][13] This inconsistency could reflect the difference between short term exercise, which might increase the risk of thrombosis by increasing inflammation and injuries to extremities, and regular exercise, which might decrease the risk of thrombosis by improving blood flow. It is also likely that overall physical activity does not fully describe an individual's lifestyle.…”

Competing Risk of Atherosclerotic Risk Factors for Arterial and Venous Thrombosis in a General Population: The Tromsø Study

“…31 The results of the present study, along with other recently published prospective studies on this topic, [32][33][34] emphasize the need of an updated systematic review.…”

Postprandial lipemia is not increased in patients with previous unprovoked venous thromboembolism

“…29,30,35 Nevertheless, in three large cohort studies [36][37][38] investigators reported no association between HDL cholesterol and VTE and a tendency toward a greater risk of unprovoked VTE in women. In the present study, patients with VTE had similar baseline HDL cholesterol as healthy controls, whereas total HDL particle concentration was greater both in the fasting and postprandial state (Tables 1 and 2).…”