title: Prospective study of subclinical atherosclerosis as a risk factor for venous thromboembolism.
abstract: BACKGROUND
  Whether atherosclerotic disease predisposes to venous thrombosis is uncertain.
  
  
  OBJECTIVE
  To determine whether subclinical atherosclerosis, manifested as increased carotid intima-media thickness (IMT) or presence of carotid plaque, is associated with increased incidence of venous thromboembolism (VTE).
  
  
  METHODS
  The Atherosclerosis Risk in Communities study is a prospective cohort of adults aged 45-64 years, examined at baseline (1987-89) and followed for cardiovascular events. Bilateral carotid ultrasound for IMT measurements was done at baseline for portions of the common and internal carotid arteries, and carotid bifurcation and also to detect the presence of carotid plaque. Exclusion criteria included baseline anticoagulant use, history of coronary heart disease, stroke, or VTE, and incomplete data. First VTE during follow-up was validated using abstracted medical records.
  
  
  RESULTS
  Among 13,081 individuals followed for a mean of 12.5 years, 225 first VTE events were identified. Unadjusted hazard ratios (HR) (95% CI) of VTE across quartiles of baseline IMT were 1.0, 1.16 (0.77-1.75), 1.64 (1.12-2.40), and 1.52 (1.03-2.25). However, this association disappeared after adjustment for age, sex, and ethnicity (HRs: 1.0, 1.06, 1.40, and 1.18). Further adjustment for body mass index and diabetes weakened the relative risks even further. Presence of carotid plaque at baseline also was not associated with VTE occurrence; adjusted HR = 0.97, 95% CI = 0.72-1.29.
  
  
  CONCLUSIONS
  Increased carotid IMT or presence of carotid plaque was not associated with an increased incidence of VTE in this middle-aged cohort, suggesting subclinical atherosclerosis itself is not a VTE risk factor.
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, 55454-1015, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Reich
authors.forename: A R
authors.initials: AR
authors.lastname: Folsom
authors.forename: N S
authors.initials: NS
authors.lastname: Key
authors.forename: L L
authors.initials: LL
authors.lastname: Boland
authors.forename: S R
authors.initials: SR
authors.lastname: Heckbert
authors.forename: W D
authors.initials: WD
authors.lastname: Rosamond
authors.forename: M
authors.initials: M
authors.lastname: Cushman
mesh_terms: D050197:Atherosclerosis / Q000150:complications* / Q000453:epidemiology; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002341:Carotid Artery Thrombosis / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology*; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology*