Lung function, respiratory symptoms and venous thromboembolism risk: the Atherosclerosis Risk in Communities Study

Y. Kubota, S. J. London, M. Cushman, Alanna Chamberlain, W. D. Rosamond, S. R. Heckbert, N. Zakai, A. R. Folsom

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Essentials The association of lung function with venous thromboembolism (VTE) is unclear. Chronic obstructive pulmonary disease (COPD) patterns were associated with a higher risk of VTE. Symptoms were also associated with a higher risk of VTE, but a restrictive pattern was not. COPD may increase the risk of VTE and respiratory symptoms may be a novel risk marker for VTE. Summary: Background The evidence for the association between chronic obstructive pulmonary disease (COPD) and venous thromboembolism (VTE) is limited. There is no study investigating the association between restrictive lung disease (RLD) and respiratory symptoms with VTE. Objectives To investigate prospectively the association of lung function and respiratory symptoms with VTE. Patients/Methods In 1987–1989, we assessed lung function by using spirometry, and obtained information on respiratory symptoms (cough, phlegm, and dyspnea) in 14 654 participants aged 45–64 years, without a history of VTE or anticoagulant use, and followed them through 2011. Participants were classified into four mutually exclusive groups: ‘COPD’ (forced expiratory volume in 1 s [FEV1]/forced vital capacity [FVC] below the lower limit of normal [LLN]), ‘RLD’ (FEV1/FVC ≥ LLN and FVC < LLN), ‘respiratory symptoms with normal spirometic results’ (without RLD or COPD), and ‘normal’ (without respiratory symptoms, RLD, or COPD). Results We documented 639 VTEs (238 unprovoked and 401 provoked VTEs). After adjustment for VTE risk factors, VTE risk was increased for individuals with either respiratory symptoms with normal spirometric results (hazard ratio [HR] 1.40, 95% confidence interval [CI] 1.12–1.73) or COPD (HR 1.33, 95% CI 1.07–1.67) but not for those with RLD (HR 1.15, 95% CI 0.82–1.60). These elevated risks of VTE were derived from both unprovoked and provoked VTE. Moreover, FEV1 and FEV1/FVC showed dose–response relationships with VTE. COPD was more strongly associated with pulmonary embolism than with deep vein thrombosis. Conclusions Obstructive spirometric patterns were associated with an increased risk of VTE, suggesting that COPD may increase the risk of VTE. Respiratory symptoms may represent a novel risk marker for VTE.

Original languageEnglish (US)
Pages (from-to)2394-2401
Number of pages8
JournalJournal of Thrombosis and Haemostasis
Volume14
Issue number12
DOIs
StatePublished - Dec 1 2016

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Venous Thromboembolism
Atherosclerosis
Lung
Chronic Obstructive Pulmonary Disease
Lung Diseases
Vital Capacity
Forced Expiratory Volume
Confidence Intervals
Pulmonary Embolism
Spirometry
Cough
Venous Thrombosis

Keywords

  • chronic obstructive pulmonary disease
  • lung function
  • respiratory symptoms
  • restrictive lung disease
  • venous thromboembolism

ASJC Scopus subject areas

  • Hematology

Cite this

Lung function, respiratory symptoms and venous thromboembolism risk : the Atherosclerosis Risk in Communities Study. / Kubota, Y.; London, S. J.; Cushman, M.; Chamberlain, Alanna; Rosamond, W. D.; Heckbert, S. R.; Zakai, N.; Folsom, A. R.

In: Journal of Thrombosis and Haemostasis, Vol. 14, No. 12, 01.12.2016, p. 2394-2401.

Research output: Contribution to journalArticle

Kubota, Y. ; London, S. J. ; Cushman, M. ; Chamberlain, Alanna ; Rosamond, W. D. ; Heckbert, S. R. ; Zakai, N. ; Folsom, A. R. / Lung function, respiratory symptoms and venous thromboembolism risk : the Atherosclerosis Risk in Communities Study. In: Journal of Thrombosis and Haemostasis. 2016 ; Vol. 14, No. 12. pp. 2394-2401.
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abstract = "Essentials The association of lung function with venous thromboembolism (VTE) is unclear. Chronic obstructive pulmonary disease (COPD) patterns were associated with a higher risk of VTE. Symptoms were also associated with a higher risk of VTE, but a restrictive pattern was not. COPD may increase the risk of VTE and respiratory symptoms may be a novel risk marker for VTE. Summary: Background The evidence for the association between chronic obstructive pulmonary disease (COPD) and venous thromboembolism (VTE) is limited. There is no study investigating the association between restrictive lung disease (RLD) and respiratory symptoms with VTE. Objectives To investigate prospectively the association of lung function and respiratory symptoms with VTE. Patients/Methods In 1987–1989, we assessed lung function by using spirometry, and obtained information on respiratory symptoms (cough, phlegm, and dyspnea) in 14 654 participants aged 45–64 years, without a history of VTE or anticoagulant use, and followed them through 2011. Participants were classified into four mutually exclusive groups: ‘COPD’ (forced expiratory volume in 1 s [FEV1]/forced vital capacity [FVC] below the lower limit of normal [LLN]), ‘RLD’ (FEV1/FVC ≥ LLN and FVC < LLN), ‘respiratory symptoms with normal spirometic results’ (without RLD or COPD), and ‘normal’ (without respiratory symptoms, RLD, or COPD). Results We documented 639 VTEs (238 unprovoked and 401 provoked VTEs). After adjustment for VTE risk factors, VTE risk was increased for individuals with either respiratory symptoms with normal spirometric results (hazard ratio [HR] 1.40, 95{\%} confidence interval [CI] 1.12–1.73) or COPD (HR 1.33, 95{\%} CI 1.07–1.67) but not for those with RLD (HR 1.15, 95{\%} CI 0.82–1.60). These elevated risks of VTE were derived from both unprovoked and provoked VTE. Moreover, FEV1 and FEV1/FVC showed dose–response relationships with VTE. COPD was more strongly associated with pulmonary embolism than with deep vein thrombosis. Conclusions Obstructive spirometric patterns were associated with an increased risk of VTE, suggesting that COPD may increase the risk of VTE. Respiratory symptoms may represent a novel risk marker for VTE.",
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AU - Cushman, M.

AU - Chamberlain, Alanna

AU - Rosamond, W. D.

AU - Heckbert, S. R.

AU - Zakai, N.

AU - Folsom, A. R.

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N2 - Essentials The association of lung function with venous thromboembolism (VTE) is unclear. Chronic obstructive pulmonary disease (COPD) patterns were associated with a higher risk of VTE. Symptoms were also associated with a higher risk of VTE, but a restrictive pattern was not. COPD may increase the risk of VTE and respiratory symptoms may be a novel risk marker for VTE. Summary: Background The evidence for the association between chronic obstructive pulmonary disease (COPD) and venous thromboembolism (VTE) is limited. There is no study investigating the association between restrictive lung disease (RLD) and respiratory symptoms with VTE. Objectives To investigate prospectively the association of lung function and respiratory symptoms with VTE. Patients/Methods In 1987–1989, we assessed lung function by using spirometry, and obtained information on respiratory symptoms (cough, phlegm, and dyspnea) in 14 654 participants aged 45–64 years, without a history of VTE or anticoagulant use, and followed them through 2011. Participants were classified into four mutually exclusive groups: ‘COPD’ (forced expiratory volume in 1 s [FEV1]/forced vital capacity [FVC] below the lower limit of normal [LLN]), ‘RLD’ (FEV1/FVC ≥ LLN and FVC < LLN), ‘respiratory symptoms with normal spirometic results’ (without RLD or COPD), and ‘normal’ (without respiratory symptoms, RLD, or COPD). Results We documented 639 VTEs (238 unprovoked and 401 provoked VTEs). After adjustment for VTE risk factors, VTE risk was increased for individuals with either respiratory symptoms with normal spirometric results (hazard ratio [HR] 1.40, 95% confidence interval [CI] 1.12–1.73) or COPD (HR 1.33, 95% CI 1.07–1.67) but not for those with RLD (HR 1.15, 95% CI 0.82–1.60). These elevated risks of VTE were derived from both unprovoked and provoked VTE. Moreover, FEV1 and FEV1/FVC showed dose–response relationships with VTE. COPD was more strongly associated with pulmonary embolism than with deep vein thrombosis. Conclusions Obstructive spirometric patterns were associated with an increased risk of VTE, suggesting that COPD may increase the risk of VTE. Respiratory symptoms may represent a novel risk marker for VTE.

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