Risk factors associated with myocardial infarction in venous thromboembolism patients

• Published in: Current medical research and opinion 2014-01, Vol.30 (1), p.27-35
• Main Authors: Laliberté, F., Nutescu, E. A., Lefebvre, P., Rondeau-Leclaire, J., Bookhart, B. K., LaMori, J. C., Damaraju, C. V., Schein, J., Kaatz, S.
• Format: Article
• Language: English
• Subjects: Anticoagulants - therapeutic use; Antihypertensive Agents - therapeutic use; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cohort Studies; Coronary Artery Disease - drug therapy; Coronary Artery Disease - epidemiology; Coronary Artery Disease - etiology; Coronary heart disease; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Heart; Humans; Insurance, Health; Longitudinal Studies; Male; Medical sciences; Middle Aged; Myocardial Infarction - complications; Myocardial Infarction - epidemiology; Myocardial infarction Venous thromboembolism; Myocarditis. Cardiomyopathies; Pharmacology. Drug treatments; Retrospective Studies; Risk Factors; Stroke - etiology; Venous Thromboembolism - drug therapy; Venous Thromboembolism - epidemiology; Venous Thromboembolism - etiology; Vitamin K - antagonists & inhibitors
• ISSN: 0300-7995; 1473-4877
• DOI: 10.1185/03007995.2013.852525

Abstract Background: Although risk factors for MI have been described in the general population, there is a lack of data on the assessment of risk factors associated with MI in venous thromboembolism (VTE) patients. Objective: The purpose of this study was to identify risk factors associated with MI in VTE patients. Patients and methods: Health insurance claims between January 2004 and September 2008 from the Ingenix IMPACT database were analyzed. Patients aged 18 years were identified as of the date of their first VTE diagnosis with 1 year of continuous insurance coverage before the index VTE. The risk of MI for VTE patients with 1, 2, and 3 major risk factors as identified by published guidelines was calculated. Multivariate Cox proportional hazard models were conducted to identify the most predictive risk factors associated with MI. Results: A total of 177,885 VTE patients were identified; 4412 (2.5%) developed an MI during a mean follow-up period of 1.3 years. Previous MI, age ( 65 years), and coronary artery disease were the most predictive risk factors of MI with adjusted hazard ratios (HRs; 95% CI) of 5.47 (5.01-5.97), 1.78 (1.66-1.91), and 1.60 (1.48-1.74), respectively. Adjusted HRs (95% CI) for VTE patients with 1, 2, and 3 major risk factors relative to no major risk factor were 2.34 (1.94-2.81), 3.21 (2.67-3.85), and 6.93 (5.85-8.22), respectively. Limitations: These included possible inaccuracies or omissions in diagnoses, classification bias such as the identification of false-positive MI events, and the likely undercoding of some risk factors such as social issues. Conclusions: Traditional major cardiovascular risk factors are also predictive of MI in VTE patients. Having multiple major risk factors significantly increases the probability of developing MI events in VTE patients.