title: Epidemiology of venous thromboembolism in the Framingham Heart Study.
abstract: BACKGROUND
  Reports of the crude incidence of venous thromboembolism (VTE) in Western countries vary widely. Data regarding risk factors, incidence and recurrence of VTE from deeply-phenotyped community-based cohort studies are needed.
  
  
  OBJECTIVE
  To study the incidence, associated mortality, and predisposing factors of VTE in the prospective, longitudinal community-based Framingham Heart Study.
  
  
  METHODS
  The study sample consisted of the Framingham Heart Study Original, Offspring, Third Generation, and Omni cohorts (N=9754). Incidence rates (IR) were standardized to the 2000 US population. Cox proportional hazards regression models were used to study risk factor associations.
  
  
  RESULTS
  During 1995-2014 (total follow-up time 104,091 person-years [median 9.8 (range 0-20) years]), 297 incident VTE events were observed. Age-adjusted IR of VTE was 20.3/10,000 (95% CI 17.9-22.6). Of the events 120 (40%) were pulmonary embolism (PE) and 177 (60%) were deep venous thrombosis (DVT); 29% were unprovoked, 40% provoked, and 31% cancer-related. Cancer-related VTE was associated with high mortality at 30days (24.2%), 1year (66.3%), and 5years (75.6%). In multivariable models, age and obesity, but no other traditional cardiovascular risk factors, were significantly associated with VTE (hazard ratio [HR] per 10-year increase in age 1.69, 95% CI 1.48-1.92; HR for obesity (BMI≥30kg/m(2)) 1.88, 95% CI 1.44-2.45).
  
  
  CONCLUSIONS
  We provide data on the epidemiology of VTE. VTE is associated with significant mortality, and prognosis after cancer-related VTE is particularly poor. Traditional cardiovascular risk factors beyond age and obesity are not associated with VTE.
authors.affiliation: Framingham Heart Study of Boston University School of Medicine and NHLBI, Framingham, MA, USA.
authors.forename: Marja K
authors.initials: MK
authors.lastname: Puurunen
authors.affiliation: University of Massachusetts Boston, Boston, MA, USA.
authors.forename: Philimon N
authors.initials: PN
authors.lastname: Gona
authors.affiliation: Framingham Heart Study of Boston University School of Medicine and NHLBI, Framingham, MA, USA; Department of Mathematics and Statistics, Boston University, Boston, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Martin G
authors.initials: MG
authors.lastname: Larson
authors.affiliation: Framingham Heart Study of Boston University School of Medicine and NHLBI, Framingham, MA, USA; Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Murabito
authors.affiliation: Framingham Heart Study of Boston University School of Medicine and NHLBI, Framingham, MA, USA; Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Jared W
authors.initials: JW
authors.lastname: Magnani
authors.affiliation: Framingham Heart Study of Boston University School of Medicine and NHLBI, Framingham, MA, USA; NHLBI Division of Intramural Research, Bethesda, MD, USA; Cardiology Section, Department of Medicine, Boston Veteran's Administration Healthcare, Boston, MA, USA. Electronic address: Christopher.odonnell@va.gov.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: O'Donnell
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000401:mortality; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000401:mortality
keywords: Deep venous thrombosis; Epidemiology; Incidence; Mortality; Pulmonary embolism; Risk factors; Venous thromboembolism