Metabolic syndrome increases risk for VTE recurrence after acute PE

Patients with acute pulmonary embolism and metabolic syndrome had higher rates of recurrent venous thromboembolism, according to a new study published in Annals of the American Thoracic Society.

“We believe this study to be novel in its overall scope because it examines the role of [metabolic syndrome] on VTE recurrence across a large cohort of patients with PE,” Lauren K. Stewart, MD, and Jeffrey A. Kline, MD, assistant professors in the department of emergency medicine at Indiana University School of Medicine, Indianapolis, wrote. “We found the presence of a composite [metabolic syndrome] profile in patients diagnosed with PE to be associated with significantly greater odds of future VTE recurrence.”

The retrospective, population-based analysis included 72,936 patients with a diagnosis of acute PE from 2004 to 2017. The mean age was 58 years and 55% were women. The researchers measured the frequency of patients with PE carrying a comorbid diagnosis of each metabolic syndrome component and then compared rates of VTE recurrence over time based on the presence or absence of metabolic syndrome.

The term “metabolic syndrome” has been used since the mid-1990s to describe a constellation of risk factors that predispose adults to develop diabetes, cardiovascular disease or both. Metabolic syndrome can include abdominal girth, elevated triglycerides or blood pressure, low LDL cholesterol or glucose abnormalities.

In this population, the most common metabolic syndrome component was hypertension (59%), followed by hyperlipidemia (41%), diabetes (24%) and obesity (22%). Of the 72,936 patients, 69% had at least one comorbid component of metabolic syndrome.

Overall VTE recurrence was 17%. VTE recurrence increased with the presence of each metabolic syndrome component, and ranged from 6% among patients with no components to 37% among patients with four components. Multivariate logistic regression analysis showed an adjusted OR of 3.03 (95% CI, 2.9-3.16) for the effect of metabolic syndrome on VTE thromboembolism recurrence.

Results also showed that the risk for VTE recurrence increased by 50% with each metabolic syndrome component, suggesting that the risk is summative, according to the researchers.

“Findings of this large, retrospective study with long-term follow-up suggest the presence of [metabolic syndrome] in patients diagnosed with PE to independently increase the risk of VTE recurrence,” the researchers wrote. “These results imply a role for increased awareness of [metabolic syndrome] risk factors in patients with newly diagnosed PE and the implementation of targeted adjuvant therapies aimed at reducing recurrence risk.”