Epidemiology of venous thromboembolism in the Framingham Heart Study

Background: Reports of the crude incidence of venous thromboembolism (VTE) in Western countries vary widely. Data regarding risk factors, incidence and recurrence of VTE from deeply-phenotyped community-based cohort studies are needed. Objectives: To study the incidence, associated mortality, and predisposing factors of VTE in the prospective, longitudinal community-based Framingham Heart Study. Patients/Methods: The study sample consisted of the Framingham Heart Study Original, Offspring, Third Generation, and Omni cohorts (N = 9754). Incidence rates (IR) were standardized to the 2000 US population. Cox proportional hazards regression models were used to study risk factor associations. Results: During 1995-2014 (total follow-up time 104,091 person-years [median 9.8 (range 0-20) years]), 297 incident VIE events were observed. Age-adjusted IR of VIE was 20.3/10,000 (95% Cl 17.9-22.6). Of the events 120 (40%) were pulmonary embolism (PE) and 177 (60%) were deep venous thrombosis (Dvr); 29% were unprovoked, 40% provoked, and 31% cancer-related. Cancer-related VTE was associated with high mortality at 30 days (24.2%), 1 year (66.3%), and 5 years (75.6%). In multivariable models, age and obesity, but no other traditional cardiovascular risk factors, were significantly associated with VTE (hazard ratio [FIR] per 10-year increase in age 1.69, 95% CI 1.48-1.92; HR for obesity (BMI 30 kg/m(2)) 1.88, 95% CI 1.44-2.45). Conclusions: We provide data on the epidemiology of VTE. VW is associated with significant mortality, and prognosis after cancer-related VIE is particularly poor. Traditional cardiovascular risk factors beyond age and obesity are not associated with VIE. Published by Elsevier Ltd.