1. The relation between venous and arterial thrombosis
Walter Ageno
Department of Clinical Medicine
University of Insubria
Varese - Italy

3. Asymptomatic atherosclerosis and deep vein thrombosis
Atherosclerosis defined by ultrasound detected carotid plaques in patients with DVT and controls
Atherosclerosis
Idiopathic DVT 47%
Secondary DVT %
Controls %
OR: 2.4 ( )
(idiopathic vs secondary or controls)
Prandoni et al, N Engl J Med 2003

4. Venous thromboembolism is associated with an increased risk of subsequent atherosclerosis

5. The long-term clinical course of PE Cardiovascular Events
0.40
Cardiovascular Events
Idiopathic PE
PE with transient RF
0.30
Cumulative Hazard
0.20
P=.005
0.10
0.00 6 12 18 24 30 36 42 48
Becattini et al., Eur Heart J 2005

7. Incidence of arterial cardiovascular events after venous thromboembolism: a systematic review and a meta-analysis
IRR
Unprovoked VTE vs
Provoked VTE ( )
Controls ( )
Becattini et al JTH 2010

8. Atherosclerosis is not associated with an increased risk of subsequent venous thromboembolism

10. Cardiovascular risk factors and venous thromboembolism

11. Cardiovascular risk factors
Obesity
Hypertension
Diabetes mellitus
Dyslipidemia
Smoking
Metabolic syndrome

12. Obesity (BMI>30 Kg/m2) Hypertension Diabetes Triglycerides levels
OR 2.33 (1.68, 3.24)
Hypertension
OR 1.51 (1.23, 1.85)
Diabetes
OR 1.41 (1.12, 1.77)
Triglycerides levels
WMD (9.64, 28.33)
HDL cholesterol levels
WMD –2.86 (-4.34, -1.38)

13. Risk of VTE and Circumference of the Waist
Arch. Int. Med. 1999; 159: 50 60 70 80 90
100 54 65 75
Age (years)
% of men without VTE after 26 years follow up
Circumf. <100 cm
Circumf. >100 cm

14. Anthropometric measures of obesity and risk of venous thromboembolism: the Tromso study
Conclusions—Our findings indicate that WC is the preferable anthropometric measure of obesity to identify subjects at risk
and to predict risk of VTE.
Borch KH ATVB 2009

15. Metabolic Syndrome and inflammation
Inflammatory adipokines:
- TNF α
- Leptin
- Interleukin – 6
CRP
Adiponectin

16. Metabolic Syndrome and risk of VTE: LITE study (12 years follow up)
Idiopathic VTE events (n:195)
Women Men
(n=11,333) (n=8,863)
Abdominal obesity (1.23, 2.95) (1.53, 3.81)
High glucose (0.57, 1.49) 1.06 (0.65, 1.72)
High triglycerides (0.49, 1.29) (0.48, 1.32)
Low HDL ( ) 1.57 ( )
Elevated blood pressure 1.29 ( ) 0.83 ( )
Met Syn ( ) 1.59 ( )
Steffen L et al JTH 2009

17. Risk of VTE in the Metabolic Syndrome: Tromso Study (11 years follow up)
Age and gender adjusted
HR (95 % CI)
Metabolic syndrome ( )
Abdominal obesity ( )
Hypertriglyceridemia ( )
Low HDL cholesterol ( )
Hypertension ( )
Impaired glucose metabolism 1.51 ( )
Borch K et al, JTH 2009

18. Common risk factors for arterial and venous thrombosis
Advanced age
Obesity
Abdominal obesity
Hormonal therapy
Metabolic syndrome
DIC
HIT
Antiphospholipid antibodies
Hyperhomocysteinemia
Cancer
Myeloproliferative neoplasms
PNH
Heart failure
Smoking
Chronic kidney failure
Nephrotic syndrome
Inflammatory bowel disease

19. The effect of primary or secondary prevention strategies for cardiovascular disease in patients with venous thromboembolism

20. Fish, fruit, and vegetable intake and the risk of VTE
Quintiles of daily nutrient intake
Servings/d p trend
Fruit and vegetables
Quintile ranges < >5.8 HR
95% CI n.s
Fish
Quintile ranges < >0.43 HR
95% CI n.s.
Red and processed meat
Quintiles ranges < >1.5 HR
95% CI n.s. n.s. n.s
Steffen LM et al Circulation 2007

21. Alcohol consumption and the risk of VTE
Alcohol consumers vs abstainers
(2-4 glasses per day resulted in the largest beneficial effect)
Overall OR 0.67 ( )
Women OR 0.66 ( )
Men OR 0.82 ( )
PE only OR 0.56 ( )
DVT only OR 0.74 ( )
Fibrinogen levels were consistently decreased, FVII and vWF levels mildly decreased but not consistently
Pomp ER et al Thromb Haemost 2008

22. Aspirin for the secondary prevention of VTE: WARFASA and ASPIRE pooled analysis
Brighton T et al NEJM 2012

23. OR 0.81 ( )

24. Statin treatment reduces the risk of recurrent pulmonary embolism
3093 patients with a first episode of PE with a mean age of 61.3 ± 17.0 years.
737 patients (24%) had at least one prescription of statins during follow-up (median duration of statin therapy: 1557 days; days).
During a median follow up of 1529 days (1-4155), 285 (9.2%) patients experienced a recurrent PE.
Biere-Rafi S et al Eur Heart J 2012

25. Statin treatment reduces the risk of recurrent pulmonary embolism
Treatment with statins reduced recurrent PE (HR 0.48, 95%CI )
The protective effect was present both during and after stopping VKA treatment.
A dose-response relationship was shown for both duration and potency
Finally, statin treatment also reduced cardiovascular events and all-cause mortality.
Biere-Rafi S et al Eur Heart J 2012

26. Conclusions
Patients with (unprovoked) VTE are at increased risk of cardiovascular events
Common risk factors may, at least in part, explain this association
Effective treatment for the primary and secondary prevention of cardiovascular disease play a role also in the prevention of VTE