Epidemiology and prevention of venous thromboembolism

Abstract

Venous thromboembolism, that consists of the interrelated conditions deep-vein thrombosis and pulmonary embolism, is an under-appreciated vascular disease. In Western regions, approximately 1 in 12 individuals will be diagnosed with venous thromboembolism in their lifetime. Rates of venous thromboembolism are lower in Asia, but data from other regions are sparse. Numerous risk factors for venous thromboembolism have been identified, which can be classified as acute or subacute triggers (provoking factors that increase the risk of venous thromboembolism) and basal or acquired risk factors (which can be modifiable or static). Approximately 20% of individuals who have a venous thromboembolism event die within 1 year (although often from the provoking condition), and complications are common among survivors. Fortunately, opportunities exist for primordial prevention (prevention of the development of underlying risk factors), primary prevention (management of risk factors among individuals at high risk of the condition) and secondary prevention (prevention of recurrent events) of venous thromboembolism. In this Review, we describe the epidemiology of venous thromboembolism, including the incidence, risk factors, outcomes and opportunities for prevention. Meaningful health disparities exist in both the incidence and outcomes of venous thromboembolism. We also discuss these disparities as well as opportunities to reduce them.

Fig. 1. Factors with protective or adverse effects on thrombosis potential and risk of VTE.

The risk of venous thromboembolism (VTE) is multifactorial. Factors that are thought to be protective and associated with a lower thrombosis potential and VTE risk are shown in blue. Factors that are considered to be harmful and associated with greater thrombosis potential and VTE risk are shown in red. Blood lipid levels, hypertension and diabetes mellitus are not shown in the figure because they are not independently associated with the risk of VTE after accounting for obesity and other risk factors.

Fig. 2. Racial/ethnic differences in VTE incidence and potential underlying factors.

The graph shows the relative risk of venous thrombosis according to racial/ethnic categories. The relative risk is based on a review of the literature on absolute risk of venous thromboembolism (VTE) in various cohort studies (see ref. for more details). The figure shows the factors that might lead to a higher or lower risk of VTE in each racial/ethnic group. Adapted with permission from ref..

Fig. 3. Cumulative incidence of VTE according to genetic risk score and the AHA Life’s Simple 7.

Cumulative incidence of venous thromboembolism (VTE) per 1,000 person-years (95% CI) according to VTE genetic risk score category. The genetic risk score categories are classified according to American Heart Association (AHA) Life’s Simple 7 categories. The cumulative incidence of VTE is greater among individuals with high VTE genetic risk scores. In each genetic risk score group, lifestyle is also associated with the risk of VTE. Specifically, regardless of genetic predisposition, individuals with optimal Life’s Simple 7 scores have the lowest risk of VTE, those with average Life’s Simple 7 scores have an intermediate risk and those with inadequate Life’s Simple 7 scores have the greatest risk of VTE. The graph is a re-analysis of data from ref..