Abstract
Background/objectives
Weight gain increases risk of cardiovascular disease, but has not been examined extensively in relationship to venous thromboembolism (VTE). The association between weight change over 9 years and subsequent VTE among participants in the Atherosclerosis Risk in Communities (ARIC) study was examined, with a hypothesis that excess weight gain is a risk factor for VTE, relative to no weight change.
Subjects/methods
Quintiles of 9-year weight change were calculated (visit 4 1996–1998 weight minus visit 1 1987–1989 weight in kg: Quintile 1: ≥−1.81 kg; Quintile 2: <−1.81 to ≤1.36 kg; Quintile 3: >1.36 to ≤4.08 kg; Quintile 4: >4.08 to ≤7.71 kg; Quintile 5: >7.71 kg). Incident VTEs from visit 4 (1996–1998) through 2015 were identified and adjudicated using medical records. Hazard ratios (HRs) were calculated using Cox models.
Results
529 incident VTEs were identified during an average of 19 years of follow up. Compared to Quintile 2, participants in Quintile 5 of weight change had 1.46 times the rate of incident VTE (HR = 1.46 (95% CI 1.09, 1.95), adjusted for age, race, sex, income, physical activity, smoking, and prevalent CVD). The HR for Quintile 5 was modestly attenuated to 1.38 (95% CI 1.03, 1.84) when visit 1 BMI was included in the model. When examined separately, results were significant for unprovoked VTE, but not for provoked VTE. Among those obese at visit 1, both weight gain (HR 1.86 95% CI 1.27, 2.71) and weight loss (HR 2.11 95% CI 1.39, 3.19) were associated with incident VTE, compared with normal-weight participants with no weight change.
Conclusions
Weight gain later life was associated with increased risk for unprovoked VTE. Among those with obesity, both weight gain and weight loss were associated with increased risk for VTE.
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References
US Department of Health and Human Services. The Surgeon General’s Call to Action to prevent deep vein thrombosis and pulmonary embolism. Rockville, MD: Office of the Surgeon General (US), National Heart, Lung and Blood Institute; 2008.
Heit JA, Spencer FA, White RH. The epidemiology of venous thromboembolism. J Thromb Thrombolysis. 2016;41:3–14.
Cushman M, Tsai AW, White RH, Heckbert SR, Rosamond WD, Enright P, et al. Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology. Am J Med. 2004;117:19–25.
Benjamin EJ, Virani SS, Callaway CW, Chang AR, Cheng S, Chiuve SE, et al. Heart disease and stroke statistics - 2019 update: a report from the American Heart Association. Circulation. 2019;139:e56–528.
Goldhaber SZ, Bounameaux H. Pulmonary embolism and deep vein thrombosis. Lancet. 2012;379:1835–46.
Braekkan SK, Siegerink B, Lijfering WM, Hansen J-B, Cannegieter SC, Rosendaal FR. Role of obesity in the etiology of deep vein thrombosis and pulmonary embolism: current epidemiological insights. Semin Thromb Hemost. 2013;39:533–40.
Horvei LD, Braekkan SK, Mathiesen EB, Njolstad I, Wilsgaard T, Hansen J-B. Obesity measures and risk of venous thromboembolism and myocardial infarction. Eur J Epidemiol. 2014;29:821–30.
Ageno W, Becattini C, Brighton T, Selby R, Kamphuisen PW. Cardiovascular risk factors and venous thromboembolism: a meta analysis. Circulation. 2008;117:93–102.
Holst AG, Jensen G, Prescott E. Risk factors for venous thromboembolism: results from the Copenhagen City Heart Study. Circulation. 2010;121:1896–903.
Cushman M, M’Meara ES, Heckbert SR, Zakai NA, Rosamond W, Folsom AR. Body size measures, hemostatic and inflammatory markers and risk of venous thrombosis: the Longitudinal Investigation of Thromboembolism Etiology. Thromb Res. 2016;144:127–32.
Olson NC, Cushman M, Lutsey PL, McClure LA, Judd S, Tracy RP, et al. Inflammation markers and incident venous thromboembolism: the REasons for geographic and racial differences in stroke (REGARDS) cohort. J Thromb Haemost. 2014;12:1993–2001.
Colditz GA, Willett WC, Rotnitzky A, Manson JE. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med. 1995;122:481–6.
Huang Z, Willett WC, Manson JE, Rosner B, Stampfer MJ, Speizer FE, et al. Body weight, weight change, and risk for hypertension in women. Ann Intern Med. 1998;128:81–8.
Lissner L, Odell PM, D’Agostino RB, Stokes J, Kreger BE, Belanger AJ, et al. Variability of body weight and health outcomes in the Framingham population. N Engl J Med. 1991;324:1839–44.
French SA, Jeffery RW, Folsom AR, Williamson DF, Byers T. Relation of weight variability and intentionality of weight loss to disease history and health-related variables in a population-based sample of women aged 55–69 years. Am J Epidemiol. 1995;142:1306–14.
Folsom AR, French SA, Zheng W, Baxter JE, Jeffery RW. Weight variability and mortality: the Iowa Women’s Health Study. Intl J Obesity Relat Metab Disord. 1996;20:704–9.
Willett WC, Manson JE, Stampfer MJ, Colditz GA, Rosner B, Speizer FE, et al. Weight, weight change, and coronary heart disease in women. Risk within the’normal’ weight range. JAMA. 1995;273:461–5.
Horvel LD, Braekkan SK, Hansen J-B. Weight change and risk of venous thromboembolism: the Tromso Study. PLoS ONE 206;11:e0168878.
The ARIC Investigators. The atherosclerosis risk in communities (ARIC) study: design and objectives. Am J Epidemiol. 1989;129:687–702.
Baecke J, Burema J, Frijters J. A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr. 1982;36:936–42.
Kritchevsky SB, Beavers KM, Miller ME, Shea MK, Houston DK, Kitzman DW, et al. Intentional weight loss and all-cause mortality: a meta-analysis of randomized clinical trials. PLoS ONE. 2015;10:e0121993.
French SA, Folsom AR, Jeffery RW, Williamson DF. Prospective study of intentionality of weight loss and mortality in older women: the Iowa Women’s Health Study. Am J Epidemiol. 1999;149:504–14.
Acknowledgements
The National Heart, Lung, and Blood Institute provided support for the ARIC study via contracts HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, and HHSN268201700005I and for this venous thromboembolism research via R01HL059367. We thank the ARIC participants and staff for their important contributions to ARIC research.
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French, S.A., Lutsey, P.L., Rosamond, W. et al. Weight change over 9 years and subsequent risk of venous thromboembolism in the ARIC cohort. Int J Obes 44, 2465–2471 (2020). https://doi.org/10.1038/s41366-020-00674-5
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DOI: https://doi.org/10.1038/s41366-020-00674-5
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