Venous Thromboembolism and Obesity: Moving Toward a Better Understanding of the Population-Attributable Risk

Q: What is the clinical evidence from this study?

Study design: Editorial. Population: Venous thromboembolism and obesity (n=35000). Intervention: Obesity (BMI ≥30 kg/m²) and Overweight (BMI 25–30 kg/m²) vs. Normal weight BMI category. Primary outcome: Incident venous thromboembolism (VTE) (HR 1.86, 95% CI 1.58-2.20).

Q: What does this research mean for the field?

Obesity accounts for approximately 25% of the population-attributable risk for incident venous thromboembolism and is associated with an 86% increased risk compared with normal weight. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Karlyn A. Martin; Neil A. Zakai

doi:10.1055/s-0043-1776010

October 9, 2023Thrombosis and HaemostasisOpen Access

Venous Thromboembolism and Obesity: Moving Toward a Better Understanding of the Population-Attributable Risk

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Key result

Obesity accounted for approximately 25% of the population-attributable risk for incident VTE and was associated with an HR of 1.86 compared to normal weight.

Why the study?

What is the population-attributable fraction of overweight and obesity for incident venous thromboembolism in a Norwegian cohort?

Key Points

To contextualize findings on the population-attributable fraction of overweight and obesity for incident venous thromboembolism and discuss methodological assumptions and prevention strategies.
Expert commentary evaluating a prospective population-based cohort investigation (the Tromsø Study, enrollment 1994–2016) comprising over 35,000 persons in Norway.
Assessed time-varying body mass index categories using age- and sex-adjusted Cox proportional hazards models to calculate the population-attributable fraction for venous thromboembolism.
Time-varying regression demonstrated a hazard ratio for venous thromboembolism of 1.4 (95% CI, 1.21–1.61) in overweight individuals and 1.86 (95% CI, 1.58–2.20) in obese individuals compared with normal-weight categories.
Obesity accounted for approximately 25% of the overall population-attributable risk for incident venous thromboembolism, representing 29% of unprovoked and 21% of provoked events across age and sex subgroups.
The commentary notes that because weight loss interventions may not reliably decrease thrombosis rates once obesity is established, clinical emphasis should prioritize primordial prevention to stop obesity from developing.

Structured PICO

What is the population-attributable fraction of overweight and obesity for incident venous thromboembolism in a Norwegian cohort?

P

Population

Over 35,000 inhabitants of Tromsø, Norway enrolled in the prospective population-based Tromsø Study between 1994 and 2016 with repeated health surveys.

E

Exposure

Overweight (BMI 25–30 kg/m²) and obesity (BMI ≥30 kg/m²) evaluated using time-varying modeling

C

Comparator

Normal weight BMI category

O

Outcome

Population-attributable fraction (PAF) and hazard ratio for incident venous thromboembolism (VTE), including unprovoked and provoked VTEhard clinical

Main Result

Hazard Ratio: 1.86 (95% CI 1.58–2.2)

Limitations

BMI was divided into categories rather than treated as a continuous variable, which may reduce accuracy in regression modeling and risk estimates.
Assumes the impact of obesity on VTE risk is monotonous across populations, ignoring potential age and genetic interactions.
Lower prevalence of overweight/obesity in the Norwegian study population (40%) compared to other populations may underestimate the attributable fraction.
Study population is presumably composed primarily of non-Hispanic white adults, limiting generalizability to more diverse populations.
PAF assumes a causal relationship and that eliminating obesity will directly lower VTE rates, though obesity-induced changes may not be readily reversible via weight loss.
BMI was divided into categories (25–30 and ≥30 kg/m²) rather than treated as a continuous variable
Assumption that the impact of obesity on VTE risk is monotonous across populations despite potential age and genetic interactions
Lower prevalence of overweight/obesity (40%) in the study cohort compared to global and US populations, which may underestimate the PAF
Lack of racial and ethnic diversity (presumably primarily non-Hispanic white adults)
PAF assumes causality and reversibility of risk upon eliminating the exposure, whereas weight loss may not actually reduce VTE risk

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

This editorial highlights that while obesity accounts for roughly 25% of the population-attributable risk for incident VTE in the Tromsø Study, underlying PAF assumptions and the lack of VTE reduction from weight loss emphasize the need for primordial prevention of obesity.

Abstract

Publication History Received: 15 September 2023 Accepted: 18 September 2023 Article published online: 09 October 2023 © 2023. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Comment to this article: The Risk of Incident Venous Thromboembolism Attributed to Overweight and Obesity: The Tromsø Study Thromb Haemost 2024; 124(03): 239-249 DOI: 10.1055/s-0043-1772212

Discussion

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Cite This Study

Martin et al. (2023) conducted an editorial in Venous thromboembolism and obesity (n=35,000). Obesity (BMI ≥30 kg/m²) and Overweight (BMI 25–30 kg/m²) vs. Normal weight BMI category was evaluated on Incident venous thromboembolism (VTE) (HR 1.86, 95% CI 1.58-2.20). Obesity accounted for approximately 25% of the population-attributable risk for incident VTE and was associated with an HR of 1.86 compared to normal weight.

synapsesocial.com/papers/6a79c97f14b028facf0dfcc9 https://doi.org/10.1055/s-0043-1776010

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Venous Thromboembolism and Obesity: Moving Toward a Better Understanding of the Population-Attributable Risk

Key Points

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Venous Thromboembolism and Obesity: Moving Toward a Better Understanding of the Population-Attributable Risk

Key Points

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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