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Distribution of body fat a factor in assessing risk for VTE
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Various measurements used to characterize obesity are also predictors of the risk for venous thromboembolism, new results from a follow-up study suggest.
Researchers recruited 27,178 men and 29,178 women aged 50 to 64 years into the Danish Diet, Cancer and Health study and followed them for a mean of 10.2 years. The researchers then used Cox proportional hazard models to assess the relationship between anthropometric variables and VTE.
A total of 56,014 participants were included in the final analysis. The researchers reported a positive association between VTE and all measurements of body mass, including body weight, BMI, total body fat mass, waist circumference and hip circumference.
Six hundred and forty-one incident VTE events were reported, with an incidence rate of 1.15 per 1,000 person-years (95% CI, 1.06-1.24). Dose-response relationships between all anthropometric measurements and VTE, even after adjustment for confounding factors such as physical activity, smoking, hormone replacement therapy, hypertension, diabetes and cholesterol levels, were reported.
The risk of VTE was higher in normal-weight individuals with high hip circumference compared with those with low hip circumference. In a mutually adjusted analysis of waist and hip circumference, the researchers reported that hip circumference was positively associated with VTE in women but not in men, and that waist circumference was positively associated with VTE in men but not in women.
The study results are consistent, according to the researchers, with results from other studies of the relationship between VTE and BMI, as well as a smaller study of the relationship between waist circumference and VTE. The researchers said that their results have generated some new information regarding a previously unexplored relationship.
“To the best of our knowledge, no studies have investigated the association between peripheral obesity, measured as hip circumference, and VTE,” the researchers wrote. “We found a statistically significant positive association between VTE and hip circumference in both men and women; however, this effect of peripheral obesity, because when people become very obese, fat accumulates all over the body, and thus, persons with a large hip circumference also have a large waist circumference. On the other hand, no association has been found between hip circumference and coronary heart disease.”
BMI is a commonly used measurement of obesity, but it does not take into account body fat distribution. Many prior studies have indicated that the distribution of body fat helps predict the future risk of cardiovascular disease. For example, peripheral obesity — an elevated hip circumference — does not seem to be nearly as strong a risk factor for CVD as central obesity (0.102 cm for men and 0.88 cm for women).
Unlike the situation with coronary heart disease risk, in this study a higher hip circumference in normal weight adults was associated with a higher risk of VTE. There was also a correlation between unprovoked VTEs and all measurements of obesity that was independent of diabetes, hypertension and dyslipidemia.
– Roger S. Blumenthal, MD
Professor of Medicine, Director, Johns Hopkins Ciccarone Center for the Prevention of Heart Disease
Increased abdominal girth characterizes metabolic syndrome which, in turn, is associated with increased catechol levels. Increased catechols increase Factor VIII that may underlie these results (at least in men).
– Harry S. Jacob, MD
HemOnc Today Chief Medical Editor
Severinsen MT. Circulation. 2009;120:1850-1857.