Major cardiovascular events (e.g. myocardial infarction (MI), coronary heart disease (CHD), angina, stroke, transient ischemic attack (TIA), and peripheral artery disease (PAD)) occur more frequently in deep vein thrombosis (DVT) patients than in the general population, but the cause of this association remains unknown. Our pre-clinical experimental data suggests that this connection could be because DVT directly accelerates atherosclerotic plaque growth. The aim of this study is to investigate whether a similar relationship exists in patients. Patients who suffer MACE often have demonstrable evidence of increased cardiovascular risk prior to their MACE, including hypertension, hypercholesterolemia, obesity, and smoking. Long term management of these conditions commonly occurs in primary care. We now would like to investigate whether patients who suffer from a DVT go on to experience more MACE secondary to atherosclerosis. We propose to carry out a prospective matched control study, comparing the risk of future MACE among patients with a DVT event with a comparison group of those who never had a DVT. We will also consider several secondary outcome measures, including all-cause mortality, QRISK score, and benefits/harms associated with blood pressure and cholesterol-based therapy. The study participants will include patients aged 40 years and over at the time of first DVT diagnosis between January 2005 and December, 2020. Patients will be stratified by their baseline cardiovascular risk based on their age, sex and recognised risk factors including smoking history, hypertension, hypercholesterolemia and family history. Data will be analysed in a time to event framework (e.g. Cox regression), adjusting for baseline confounders using competing risk analysis. If there is an association between DVT and atherosclerosis, it would lead to a change in clinical practice to modify vascular risk factors in patients following DVT with the potential to save many lives.
The main outcome measure of the study is major cardiovascular events including myocardial infarction (MI), coronary heart disease (CHD), angina, stroke, transient ischaemic attack (TIA), and peripheral artery disease (PAD) identified using SNOMED-CT medical codes. Several secondary outcome will be investigated to include All-cause mortality; QRisk score; Blood pressure and/or total cholesterol treatment associated benefits/harms (e.g., hypotension, syncope, acute kidney injury).
Prakash Saha - Chief Investigator - King's College London (KCL)
Alex Dregan - Corresponding Applicant - King's College London (KCL)
Clemens Gutmann - Collaborator - King's College London (KCL)
Xiaohui Sun - Collaborator - King's College London (KCL)