Patients with newly diagnosed deep vein thrombosis (DVT) who have components of metabolic syndrome – hypertension, hyperlipidemia, diabetes mellitus, or obesity – have a higher risk for experiencing a recurrent venous thromboembolism (VTE), according to a study published in Blood Advances. Cancer, congestive heart failure (CHF), and chronic kidney disease (CKD) are also associated with higher mortality rates in patients with DVT.
Lauren Stewart, MD, and Jeffrey Kline, MD, from the Indiana University School of Medicine, performed a retrospective population-based analysis to assess the prevalence of metabolic syndrome and the associated risk of VTE recurrence. They reviewed deidentified patient data from 151,054 people enrolled in the Indiana Network for Patient Care database who had a newly diagnosed DVT between 2004 and 2017.
Diagnoses of DVT were identified by International Classification of Diseases (ICD) codes. This coding also was used to determine the presence or absence of the following four components of metabolic syndrome:
- diabetes mellitus
Drs. Stewart and Kline also evaluated the association between VTE recurrence and mortality with atrial fibrillation, CHF, CKD, cancer, chronic obstructive pulmonary disease, depression, anxiety, medication history, smoking history, and return visits to the emergency department within 2 years following a diagnosis of DVT.
In this large cohort, 68% of patients had at least one comorbid component of metabolic syndrome. The most common condition was hypertension (58%), followed by hyperlipidemia (41%), diabetes (23%), and obesity (19%). Individuals with fewer metabolic syndrome criteria were more often younger, less likely to smoke, and had fewer comorbidities overall, the authors reported.
The overall mortality rate in this patient population was 16%, and the rate of VTE recurrence was 17%. The incidence of recurrent VTE increased in a stepwise fashion according to the number of metabolic syndrome components. For example:
- 0 components: 7%
- 1 component: 14%
- 2 components: 21%
- 3 components: 37%
Next, in a multivariate logistic regression analysis, the researchers found an association between likelihood of VTE recurrence and the following conditions:
- hyperlipidemia (odds ratio [OR] = 1.8; 95% CI 1.72-1.84)
- obesity (OR=1.5; 95% CI 1.48-1.59)
- hypertension (OR=1.5; 95% CI 1.41-1.53)
- diabetes mellitus (OR=1.4; 95% CI 1.38-1.47)
In addition, the following conditions were associated with a greater risk of mortality:
- CHF (OR=2.1; 95% CI 2.06-2.22)
- cancer (OR=2.0; 95% CI 1.92-2.07)
- CKD (OR=1.7; 95% CI 1.61-1.73)
However, the following conditions possessed negative associations with mortality in a logistic regression analysis: hyperlipidemia, obesity, anxiety, diabetes mellitus, and smoking history.
A significantly greater proportion of patients with the composite metabolic syndrome profile had a prescription for anticoagulation therapy compared with patients without metabolic syndrome (23% vs. 18%, respectively; p<0.0001). The authors also observed that patients with metabolic syndrome had a significantly longer time from the index DVT diagnosis to the most recent documented anticoagulant, compared with those without metabolic syndrome (92 days vs. 50 days, respectively; p<0.0001).
“Unlike age and many other comorbid conditions, the components of metabolic syndrome can be reversed or at least attenuated with treatment,” Dr. Stewart told ASH Clinical News. “We believe these data imply the need for a multifaceted approach to overall management.”
She noted that “in addition to pharmacologic agents aimed at treatment of the components of metabolic syndrome, including statins, antihypertensives, and anti-glycemic agents, other targeted interventions might include dietary education or enrollment in an exercise program, which has been previously shown to produce an antithrombotic effect.”
The authors also agreed that starting a home-based walking program may be of particular interest in this patient population, because it is less resource-intensive and permits more flexibility in implementation.
Limitations of the study included its retrospective nature and the reliance on ICD coding for DVT identification, which may have been under-coded. In addition, the study design limited the investigators’ ability to determine whether the components of metabolic syndrome were treated or untreated, and how treatment or lack thereof could have affected patient outcomes.
“Further study is needed to explore whether the targeted treatment of these metabolic syndrome components attenuates future risk of VTE and, if so, how best to address these risk factors through a systems-based approach,” Dr. Stewart concluded.
The authors reported no relevant conflicts of interest.
Stewart LK, Kline JA. Metabolic syndrome increases risk of venous thromboembolism recurrence after acute deep vein thrombosis. Blood Adv. 2020;4:127-35.