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【medical-news】超重--静脉血栓栓塞再发的危险因素
August 12, 2008 — Excess body weight is a risk factor for recurrent venous thromboembolism, according to the results of a study reported in the August 11/25 issue of the Archives of Internal Medicine.
"Excess body weight is a risk factor for a first venous thromboembolism," write Sabine Eichinger, MD, from Medical University of Vienna in Austria, and colleagues. "The impact of excess body weight on risk of recurrent venous thrombosis is uncertain."
The study cohort consisted of 1107 patients observed for an average of 46 months after a first unprovoked venous thromboembolism and withdrawal of anticoagulant therapy. Exclusion criteria were pregnancy, need for long-term antithrombotic treatment, a history of previous or secondary thrombosis, natural coagulation inhibitor deficiency, lupus anticoagulant, or cancer.
The primary outcome measure was symptomatic recurrent venous thromboembolism. Body mass index (BMI) was calculated as weight in kilograms divided by height in meters squared.
Recurrent venous thromboembolism occurred in 168 patients. Patients with recurrence had higher mean BMI vs those without recurrence (28.5 ± 6.0 vs 26.9 ± 5.0; P = .01). There was a linear relationship between excess body weight and recurrence, with the adjusted hazard ratio (HR) for each 1-point increase in BMI being 1.044 (95% confidence interval [CI], 1.013 - 1.076; P < .001).
The probability of recurrence 4 years after discontinuation of anticoagulant therapy was 9.3% (95% CI, 6.0% - 12.7%) in patients of normal weight, 16.7% (95% CI, 11.0% - 22.3%) in overweight patients, and 17.5% (95% CI, 13.0% - 22.0%) in obese patients.
After adjustment for age, sex, factor V Leiden, prothrombin G20210A mutation, high factor VIII levels, and type of initial venous thromboembolic event, the HR of recurrence vs patients of normal weight was 1.3 (95% CI, 0.9 - 1.9; P = .20) in overweight patients and 1.6 (95% CI, 1.1 - 2.4; P = .02) in obese patients.
"The population attributable risk corresponding to excess body weight was 26.8% (95% CI, 5.3% - 48.2%)," the study authors write. "Excess body weight is a risk factor of recurrent venous thromboembolism."
Limitations of this study include inability to extrapolate to patients with venous thrombosis related to surgery, trauma, pregnancy, or cancer; assessment of excess body weight by BMI, which does not consider fat distribution; lack of data on central obesity; and inability to evaluate the effect of weight change throughout the follow-up period.
"Health care professionals should be encouraged to emphasize the need for weight control when counseling overweight or obese patients with thrombosis," the study authors conclude. "Since the association between excess body weight and the risk of recurrence is linear, even a small weight loss might translate into a reduction of the risk of recurrent thrombosis. Patients of normal weight who have had a thrombosis should be told that weight gain might increase their future risk of venous thrombosis."
The Medizinisch-wissenschaftlicher Fonds des Bürgermeisters der Bundeshauptstadt Wien and the Wiener Wechselseitige Städtische Versicherun supported this study. Dr. Eichinger has obtained funding. The other study authors have disclosed no relevant financial relationships.
Arch Intern Med. 2008;168:1678-1683. 该文已经发过：
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作者:admin@医学,生命科学 2010-11-22 05:11
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