title: Protein C, antithrombin, and venous thromboembolism incidence: a prospective population-based study.
abstract: Although deficiencies of protein C and antithrombin, 2 natural plasma anticoagulants, are known risk factors for venous thrombosis, population-based prospective incidence data on these associations are lacking. Venous thromboembolic events have been identified in adults in 2 longitudinal cohort studies, the Atherosclerosis Risk in Communities (ARIC) Study and the Cardiovascular Health Study (CHS). Incidence was examined in relation to prediagnostic plasma levels of protein C (ARIC Study only) and antithrombin. Over a mean of 8.1 years of follow-up, there were 130 incident venous thromboembolic events that were not due to cancer in the ARIC Study. The age-adjusted incidence was elevated 3.36-fold (95% CI 1.24 to 9.11) in the 1.1% of subjects with protein C values <2.0 mg/L compared with subjects with higher values. In contrast, in the ARIC Study and the CHS, there was no association between low plasma antithrombin and venous thromboembolism. In conclusion, in this population-based study, a low protein C, but not antithrombin, level has been determined to be associated with an increased incidence of venous thromboembolism. Attributable risk estimates suggest that low protein C levels account for approximately 2.5% of venous thromboembolic events in the ARIC population.
authors.affiliation: Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55454-1015, USA. folsom@epi.umn.edu
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Folsom
authors.forename: Nena
authors.initials: N
authors.lastname: Aleksic
authors.forename: Lu
authors.initials: L
authors.lastname: Wang
authors.forename: Mary
authors.initials: M
authors.lastname: Cushman
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Wu
authors.forename: Richard H
authors.initials: RH
authors.lastname: White
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000991:Antithrombins / Q000378:metabolism*; D001161:Arteriosclerosis / Q000453:epidemiology; D015331:Cohort Studies; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008875:Middle Aged; D016017:Odds Ratio; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies; D011486:Protein C / Q000378:metabolism*; D020151:Protein C Deficiency / Q000453:epidemiology; D011655:Pulmonary Embolism / Q000453:epidemiology; D013923:Thromboembolism / Q000453:epidemiology*; D020246:Venous Thrombosis / Q000453:epidemiology
chemical_list: D000991:Antithrombins; D011486:Protein C