Abstract and Introduction
Abstract
The authors investigated diet as a risk factor for the development of venous thromboembolism (VTE) among 129,430 US women and men in the Nurses' Health Study and Health Professionals Follow-up Study. There were 2,892 cases of VTE from 1984 through 2008. Information on participants' dietary intakes was collected every 2–4 years using a food frequency questionnaire. Dietary patterns (prudent vs. Western), food intakes (fruit, vegetables, fish, red and processed meats, and alcohol), and nutrient intakes (omega-3 fatty acids, trans fatty acids, total fiber, and vitamins K1, B6, B12, and E) were categorized into quintiles, and the risk of VTE was compared among quintiles with the use of Cox proportional hazard models. After adjusting the results for 17 potential confounders, the authors found that adherence to the Western dietary pattern was associated with an increased risk of VTE in men (for the highest quintile vs. the lowest, relative risk = 1.43, 95% confidence interval: 1.16, 1.78; P for trend < 0.001) but not in women (relative risk = 1.14, 95% confidence interval: 0.91, 1.42; P for trend = 0.09). Favorable associations were found in the pooled analysis for intakes of vitamins E and B6 and fiber. For intakes of red and processed meat and trans fatty acids, no association was found in women, whereas a significant positive association was found in men. These results suggest a weak association between diet and the risk of VTE.
Introduction
The annual incidence of venous thromboembolism (VTE) in the United States is approximately 1 per 1,000 adults. Among nonfatal VTEs, approximately 60% are cases of deep vein thrombosis (DVT) and 40% are cases of nonfatal pulmonary embolism (PE). Arterial thrombosis and venous thrombosis share multiple risk factors, the strongest of which are age, obesity, cigarette smoking, and hypertension. However, little is known about the relation between diet and VTE.
A relation between diet and VTE was suggested as early as World War II. However, to our knowledge, there have only been 2 prospective epidemiologic studies—the Atherosclerosis Risk in Communities (ARIC) Study and the Iowa Women's Health Study (IWHS)—in which investigators have systematically examined the role of dietary patterns in the development of VTE, and the results of those studies conflicted. There have been 8 studies in which investigators have explored the relation between alcohol and VTE; in 4 of those studies, an inverse association was reported, whereas no relation was found in the other 4. The relation between specific nutrients and coagulation factor levels has been evaluated more broadly. Vitamins B6 and B12 have been shown to reduce elevated homocysteine levels, which are associated with an increased VTE risk; omega-3 fatty acids decrease platelet aggregation and factor VII and fibrinogen levels; and vitamin E might inhibit the biologic activity of vitamin K and vitamin K-dependent clotting factors. However, little is known about the potential role of these nutrients in the development of VTE.
The aim of the present study was to better define the association between dietary intake and the risk of VTE by analyzing cohort data from approximately 130,000 US women and men.