High-density lipoprotein and the risk of recurrent venous thromboembolism.
BACKGROUND
High-density lipoprotein (HDL) protects against arterial atherothrombosis, but it is unknown whether it protects against recurrent venous thromboembolism.


RESULTS
We studied 772 patients after a first spontaneous venous thromboembolism (average follow-up 48 months) and recorded the end point of symptomatic recurrent venous thromboembolism, which developed in 100 of the 772 patients. The relationship between plasma lipoprotein parameters and recurrence was evaluated. Plasma apolipoproteins AI and B were measured by immunoassays for all subjects. Compared with those without recurrence, patients with recurrence had lower mean (+/-SD) levels of apolipoprotein AI (1.12+/-0.22 versus 1.23+/-0.27 mg/mL, P<0.001) but similar apolipoprotein B levels. The relative risk of recurrence was 0.87 (95% CI, 0.80 to 0.94) for each increase of 0.1 mg/mL in plasma apolipoprotein AI. Compared with patients with apolipoprotein AI levels in the lowest tertile (<1.07 mg/mL), the relative risk of recurrence was 0.46 (95% CI, 0.27 to 0.77) for the highest-tertile patients (apolipoprotein AI >1.30 mg/mL) and 0.78 (95% CI, 0.50 to 1.22) for midtertile patients (apolipoprotein AI of 1.07 to 1.30 mg/mL). Using nuclear magnetic resonance, we determined the levels of 10 major lipoprotein subclasses and HDL cholesterol for 71 patients with recurrence and 142 matched patients without recurrence. We found a strong trend for association between recurrence and low levels of HDL particles and HDL cholesterol.


CONCLUSIONS
Patients with high levels of apolipoprotein AI and HDL have a decreased risk of recurrent venous thromboembolism.
Eichinger
Sabine
S
Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria.
Pecheniuk
Natalie M
NM
Hron
Gregor
G
Deguchi
Hiroshi
H
Schemper
Michael
M
Kyrle
Paul A
PA
Griffin
John H
JH
D000328:Adult; D000368:Aged; D017152:Antibodies, Antiphospholipid / Q000097:blood; D016632:Apolipoprotein A-I / Q000097:blood; D001055:Apolipoproteins B / Q000097:blood; D001317:Austria / Q000453:epidemiology; D008076:Cholesterol, HDL / Q000097:blood; D015331:Cohort Studies; D004198:Disease Susceptibility; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008075:Lipoproteins, HDL / Q000097:blood / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D019906:Nuclear Magnetic Resonance, Biomolecular; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000097:blood / Q000453:epidemiology*; D012008:Recurrence; D012306:Risk; D012307:Risk Factors; D012737:Sex Factors; D019851:Thrombophilia / Q000097:blood*; D020246:Venous Thrombosis / Q000097:blood / Q000453:epidemiology*
D017152:Antibodies, Antiphospholipid; D016632:Apolipoprotein A-I; D001055:Apolipoproteins B; D008076:Cholesterol, HDL; D008075:Lipoproteins, HDL