Bakhtawar K Mahmoodi1, Nic J G M Veeger2, Saskia Middeldorp2, Willem M Lijfering2, Jan-Leendert P Brouwer2, Jur Ten Berg2, Karly Hamulyák2, Karina Meijer2. 1. Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands (B.K.M., J.t.B.); Division of Hemostasis & Thrombosis, Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (B.K.M., N.J.G.M.V., K.M.); Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (S.M.); Department of Clinical Epidemiology, Leiden University Medical Center, University of Leiden, Leiden, The Netherlands (W.M.L.); Department of Cardiology, de Sionsberg Hospital, Dokkum, The Netherlands (J.-L.P.B.); and Department of Hematology, Maastricht University Medical Center, University of Maastricht, Maastricht, The Netherlands (K.H.). b.k.mahmoodi@umcg.nl. 2. Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands (B.K.M., J.t.B.); Division of Hemostasis & Thrombosis, Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (B.K.M., N.J.G.M.V., K.M.); Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (S.M.); Department of Clinical Epidemiology, Leiden University Medical Center, University of Leiden, Leiden, The Netherlands (W.M.L.); Department of Cardiology, de Sionsberg Hospital, Dokkum, The Netherlands (J.-L.P.B.); and Department of Hematology, Maastricht University Medical Center, University of Maastricht, Maastricht, The Netherlands (K.H.).
Abstract
BACKGROUND: Hereditary thrombophilia is associated with a slightly increased risk of arterial thromboembolism (ATE). Whether hereditary thrombophilia interacts with traditional cardiovascular risk factors on the risk of ATE has yet to be established. METHODS AND RESULTS: A total of 1891 individuals belonging to 4 family cohorts from the Netherlands were included in the analyses. Five hereditary thrombophilic defects, including factor V Leiden, prothrombin G20210A defect, and deficiencies of the natural anticoagulants (ie, antithrombin, protein C, and protein S), were assessed, and data on risk factors and previous ATE were collected. Thrombophilia was associated with elevated risk of ATE (hazard ratio =1.74, 95% confidence interval, 1.18-2.58; P=0.005). Overall, the association of thrombophilia with ATE tended to be stronger in the presence of traditional cardiovascular risk factors, especially the synergistic effect of thrombophilia with diabetes mellitus was striking (hazard ratio of thrombophilia-ATE association was 1.41 in nondiabetics versus 8.11 in diabetics). Moreover, the association of thrombophilia with ATE tended to be stronger in females and before the age of 55 years as compared with males and individuals >55 years of age, respectively. CONCLUSIONS: Thrombophilia is associated with ATE. This association may be stronger in the presence of traditional cardiovascular risk factors in particular in individuals with diabetes mellitus. Future studies on thrombophilia-ATE risk should focus on high-risk populations with high prevalence of traditional cardiovascular risk factors.
BACKGROUND:Hereditary thrombophilia is associated with a slightly increased risk of arterial thromboembolism (ATE). Whether hereditary thrombophilia interacts with traditional cardiovascular risk factors on the risk of ATE has yet to be established. METHODS AND RESULTS: A total of 1891 individuals belonging to 4 family cohorts from the Netherlands were included in the analyses. Five hereditary thrombophilic defects, including factor V Leiden, prothrombin G20210A defect, and deficiencies of the natural anticoagulants (ie, antithrombin, protein C, and protein S), were assessed, and data on risk factors and previous ATE were collected. Thrombophilia was associated with elevated risk of ATE (hazard ratio =1.74, 95% confidence interval, 1.18-2.58; P=0.005). Overall, the association of thrombophilia with ATE tended to be stronger in the presence of traditional cardiovascular risk factors, especially the synergistic effect of thrombophilia with diabetes mellitus was striking (hazard ratio of thrombophilia-ATE association was 1.41 in nondiabetics versus 8.11 in diabetics). Moreover, the association of thrombophilia with ATE tended to be stronger in females and before the age of 55 years as compared with males and individuals >55 years of age, respectively. CONCLUSIONS:Thrombophilia is associated with ATE. This association may be stronger in the presence of traditional cardiovascular risk factors in particular in individuals with diabetes mellitus. Future studies on thrombophilia-ATE risk should focus on high-risk populations with high prevalence of traditional cardiovascular risk factors.
Keywords:
arterial thrombosis; cardiovascular disease; epidemiology; factor V Leiden; hereditary thrombophilia; protein C deficiency; protein S deficiency; prothrombin G20210A
Authors: Lars Wallentin; Folkert W Asselbergs; Riyaz S Patel; Bakhtawar K Mahmoodi; Vinicius Tragante; Marcus E Kleber; Michael V Holmes; Amand F Schmidt; Raymond O McCubrey; Laurence J Howe; Kenan Direk; Hooman Allayee; Ekaterina V Baranova; Peter S Braund; Graciela E Delgado; Niclas Eriksson; Crystel M Gijsberts; Yan Gong; Jaana Hartiala; Mahyar Heydarpour; Gerard Pasterkamp; Salma Kotti; Pekka Kuukasjärvi; Petra A Lenzini; Daniel Levin; Leo-Pekka Lyytikäinen; Jochen D Muehlschlegel; Christopher P Nelson; Kjell Nikus; Anna P Pilbrow; W H Wilson Tang; Sander W van der Laan; Jessica van Setten; Ragnar O Vilmundarson; John Deanfield; Panos Deloukas; Frank Dudbridge; Stefan James; Ify R Mordi; Andrej Teren; Thomas O Bergmeijer; Simon C Body; Michiel Bots; Ralph Burkhardt; Rhonda M Cooper-DeHoff; Sharon Cresci; Nicolas Danchin; Robert N Doughty; Diederick E Grobbee; Emil Hagström; Stanley L Hazen; Claes Held; Imo E Hoefer; G Kees Hovingh; Julie A Johnson; Marcin P Kaczor; Mika Kähönen; Olaf H Klungel; Jari O Laurikka; Terho Lehtimäki; Anke H Maitland-van der Zee; Ruth McPherson; Colin N Palmer; Adriaan O Kraaijeveld; Carl J Pepine; Marek Sanak; Naveed Sattar; Markus Scholz; Tabassome Simon; John A Spertus; Alexandre F R Stewart; Wojciech Szczeklik; Joachim Thiery; Frank L J Visseren; Johannes Waltenberger; A Mark Richards; Chim C Lang; Vicky A Cameron; Axel Åkerblom; Guillaume Pare; Winfried März; Nilesh J Samani; Aroon D Hingorani; Jurriën M Ten Berg Journal: Circulation Date: 2020-07-13 Impact factor: 29.690
Authors: Joakim K Sejrup; Vania M Morelli; Maja-Lisa Løchen; Inger Njølstad; Ellisiv B Mathiesen; Tom Wilsgaard; John-Bjarne Hansen; Sigrid K Brækkan Journal: Res Pract Thromb Haemost Date: 2020-01-27