TY - JOUR
T1 - Prospective study of plasma D-dimer and incident venous thromboembolism
T2 - The Atherosclerosis Risk in Communities (ARIC) Study
AU - Folsom, Aaron R.
AU - Alonso, Alvaro
AU - George, Kristen M.
AU - Roetker, Nicholas S.
AU - Tang, Weihong
AU - Cushman, Mary
N1 - Publisher Copyright:
© 2015 Elsevier Ltd. All rights reserved.
PY - 2015/10/1
Y1 - 2015/10/1
N2 - Introduction Plasma D-dimer is a useful clinical test for acute venous thromboembolism (VTE), and concentrations remain higher in VTE patients after treatment than in controls. Yet, evidence is limited on whether higher basal D-dimer concentrations in the general population are associated with greater risk of first VTE. Objective To assess the prospective association between D-dimer and incident VTE over a long follow-up. Methods We measured plasma D-dimer in 12,097 participants, initially free of VTE, in the Atherosclerosis Risk in Communities Study. Over a median follow-up of 17 years, we identified 521 VTEs. We calculated hazard ratios of VTE using proportional hazards regression. Results The age, race, and sex adjusted hazard ratios of VTE across quintiles of D-dimer were 1, 1.5, 1.8, 2.1, and 3.2 (p for trend < 0.0001). For the first 10 years of follow-up, the hazard ratio for the highest versus lowest quintile was 3.5, and was 2.9 after 10 years. In both whites and African Americans, VTE risk remained strongly associated with D-dimer after further adjustment for diabetes, body mass index, kidney function, and several thrombophilia genetic markers. D-dimer was associated with both unprovoked and provoked VTE, but more strongly with unprovoked. Conclusions A higher basal level of plasma D-dimer in the general population, presumably reflecting a predisposition to thrombosis, is a strong, long-term risk factor for a first VTE.
AB - Introduction Plasma D-dimer is a useful clinical test for acute venous thromboembolism (VTE), and concentrations remain higher in VTE patients after treatment than in controls. Yet, evidence is limited on whether higher basal D-dimer concentrations in the general population are associated with greater risk of first VTE. Objective To assess the prospective association between D-dimer and incident VTE over a long follow-up. Methods We measured plasma D-dimer in 12,097 participants, initially free of VTE, in the Atherosclerosis Risk in Communities Study. Over a median follow-up of 17 years, we identified 521 VTEs. We calculated hazard ratios of VTE using proportional hazards regression. Results The age, race, and sex adjusted hazard ratios of VTE across quintiles of D-dimer were 1, 1.5, 1.8, 2.1, and 3.2 (p for trend < 0.0001). For the first 10 years of follow-up, the hazard ratio for the highest versus lowest quintile was 3.5, and was 2.9 after 10 years. In both whites and African Americans, VTE risk remained strongly associated with D-dimer after further adjustment for diabetes, body mass index, kidney function, and several thrombophilia genetic markers. D-dimer was associated with both unprovoked and provoked VTE, but more strongly with unprovoked. Conclusions A higher basal level of plasma D-dimer in the general population, presumably reflecting a predisposition to thrombosis, is a strong, long-term risk factor for a first VTE.
KW - D-dimer
KW - Deep vein thrombosis
KW - Prospective studies
KW - Pulmonary embolism
KW - Risk factors
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U2 - 10.1016/j.thromres.2015.08.013
DO - 10.1016/j.thromres.2015.08.013
M3 - Article
C2 - 26337932
AN - SCOPUS:84941876972
SN - 0049-3848
VL - 136
SP - 781
EP - 785
JO - Thrombosis Research
JF - Thrombosis Research
IS - 4
ER -