Overweight, obesity, and the risk of recurrent venous thromboembolism

被引:255
作者
Eichinger, Sabine [1 ]
Hron, Gregor [1 ]
Bialonczyk, Christine [5 ]
Hirschl, Mirko [6 ]
Minar, Erich [2 ]
Wagner, Oswald [3 ]
Heinze, Georg [4 ]
Kyrle, Paul A. [1 ]
机构
[1] Med Univ Vienna, Dept Internal Med 1, A-1090 Vienna, Austria
[2] Med Univ Vienna, Dept Internal Med 2, A-1090 Vienna, Austria
[3] Med Univ Vienna, Inst Med & Chem Lab Diagnost, A-1090 Vienna, Austria
[4] Med Univ Vienna, Core Unit Med Stat & Informat, A-1090 Vienna, Austria
[5] Wilhelminenspital Stadt Wien, Dept Dermatol, Vienna, Austria
[6] Hanuschkrankenhaus, Dept Angiol, Vienna, Austria
关键词
D O I
10.1001/archinte.168.15.1678
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Excess body weight is a risk factor for a first venous thromboembolism. The impact of excess body weight on risk of recurrent venous thrombosis is uncertain. Methods: We studied 1107 patients for an average of 46 months after a first unprovoked venous thromboembolism and withdrawal of anticoagulant therapy. Excluded were pregnant patients, those requiring long-term antithrombotic treatment, and those who had a previous or secondary thrombosis, natural coagulation inhibitor deficiency, lupus anticoagulant, or cancer. Our study end point was symptomatic recurrent venous thromboembolism. Results: A total of 168 patients had recurrent venous thromboembolism. Mean (SD) body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) was significantly higher among patients with recurrence than among those without recurrence: 28.5 (6.0) vs 26.9 (5.0) (P=.01). The relationship between excess body weight and recurrence was linear; the adjusted hazard ratio for each 1-point increase in BMI was 1.044 (95% confidence interval [CI], 1.013-1.076) (P<.001). Four years after discontinuation of anticoagulant therapy, the probability of recurrence was 9.3% (95% CI, 6.0%-12.7%) among patients of normal weight and 16.7% (95% CI, 11.0%-22.3%) and 17.5% (95% CI, 13.0%-22.0%) among overweight and obese patients, respectively. Compared with patients of normal weight, the hazard ratio of recurrence adjusted for age, sex, factor V Leiden, prothrombin G20210A mutation, high factor VIII levels, and type of initial venous thromboembolic event was 1.3 (95% CI, 0.9-1.9) (P=.20) among overweight patients and 1.6 (95% CI, 1.1-2.4) (P=.02) among obese individuals. The population attributable risk corresponding to excess body weight was 26.8% (95% CI, 5.3%-48.2%). Conclusion: Excess body weight is a risk factor of recurrent venous thromboembolism.
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收藏
页码:1678 / 1683
页数:6
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