title: Insulin resistance and risk of venous thromboembolism: results of a population-based cohort study.
abstract: BACKGROUND
  Obesity is an established risk factor for venous thromboembolism (VTE), but it is uncertain how this is mediated. Insulin resistance has a central role in the pathophysiology of the metabolic effects of obesity.
  
  
  OBJECTIVE
  We aimed to investigate whether insulin resistance is a risk factor for VTE.
  
  
  METHODS
  For this analysis we used the PREVEND prospective community-based observational cohort study. Insulin resistance was measured as HOMA-IR (homeostasis model assessment of insulin resistance) and fasting insulin. VTE was assessed using databases of the national registries of hospital discharge diagnoses, death certificates and the regional anticoagulation clinic.
  
  
  RESULTS
  Out of 7393 subjects, 114 developed VTE during a median follow-up of 10.5 years. High HOMA-IR was associated with increased risk of VTE after adjustment for traditional cardiovascular risk factors, CRP and markers of endothelial dysfunction (hazard ratio [HR], 1.38; 95% confidence interval [95% CI], 1.09-1.75; P=0.007). When body mass index (BMI) was added to the model, BMI was a strong risk predictor for VTE (HR, 1.53; 95% CI, 1.24-1.88; P<0.001) whereas HOMA-IR no longer showed such an association (HR, 1.11; 95% CI, 0.85-1.43; P=0.45). Results were similar for fasting insulin.
  
  
  CONCLUSIONS
  Our population-based cohort study shows an increased risk of VTE in subjects with increasing insulin resistance but not independently of BMI.
authors.affiliation: Division of Hemostasis and Thrombosis, Department of Hematology, University Medical Center Groningen, Groningen, the Netherlands. i.m.schouwenburg@umcg.nl
authors.forename: I M
authors.initials: IM
authors.lastname: Van Schouwenburg
authors.forename: B K
authors.initials: BK
authors.lastname: Mahmoodi
authors.forename: N J G M
authors.initials: NJ
authors.lastname: Veeger
authors.forename: S J L
authors.initials: SJ
authors.lastname: Bakker
authors.forename: H C
authors.initials: HC
authors.lastname: Kluin-Nelemans
authors.forename: K
authors.initials: K
authors.lastname: Meijer
authors.forename: R T
authors.initials: RT
authors.lastname: Gansevoort
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D009765:Obesity / Q000097:blood / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D054556:Venous Thromboembolism / Q000097:blood / Q000453:epidemiology*
chemical_list: D015415:Biomarkers; D007328:Insulin