Venous Thromboembolism - A Manifestation of the Metabolic Syndrome?.

There is accumulating evidence for an association between atherosclerosis and venous thrombosis, which may share common risk factors. The metabolic syndrome (MetSyn), a cluster of interrelated risk factors comprising abdominal obesity, elevated blood pressure, high triglycerides, reduced high-density lipoprotein cholesterol and elevated fasting glucose plasma levels is associated with atherosclerotic disease and type 2 diabetes mellitus. It induces a proinflammatory and prothrombotic state. Despite its high prevalence, data on the association with venous thromboembolism (VTE) are scarce. Therefore, we aimed to investigate the association of the MetSyn with the risk for VTE and conducted a case-control study to evaluate the prevalence of the MetSyn according to guidelines of the National Cholesterol Education Program in a high-risk population of patients with objectively confirmed recurrent VTE, who had at least one unprovoked event of deep venous thrombosis or pulmonary embolism. Age and sex-matched healthy individuals served as controls. Finally, a total of 116 patients (53 female, mean age +/−SD: 56 years +/−12) and 129 controls (66 female, mean age +/−SD: 53 years +/−11) were recruited between January 2005 and November 2005. The prevalence of the MetSyn was statistically significantly higher in patients (40/116, 35%) than in controls (26/129, 20%, p=0.012). The unadjusted odds ratio (OR) of the MetSyn for VTE was 2.1 (95% CI [1.2–3.7], p=0.012) and remained statistically significant after adjustment for factor V Leiden, prothrombin G20210A variation and elevated factor VIII activity, sex and age (OR=2.2, 95% CI [1.1–4.2], p=0.024). Furthermore, individuals with the MetSyn (n=66) had significantly higher hs-CRP (median, [interquartile range]: 0.312 mg/dL, [0.142–0.751] vs. 0.153 mg/dL, [0.073–0.330], p<0.001), fibrinogen (390 mg/dL, [342–432] vs. 343 mg/dL, [310–394], p<0.001) and factor VIII activity (182%, [157–216] vs. 159%, [133–199], p=0.005) compared to those without (n=179). In conclusion, the MetSyn was statistically significantly overrepresented in patients with VTE compared to control subjects without a history of venous or arterial thrombosis. Our data suggest that the MetSyn may contribute to the development of VTE as it was associated with a 2-fold increased risk for VTE.