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Metabolic syndrome and VTE risk

Metabolic syndrome associated with increased risk of VTE

The presence of comorbid metabolic syndrome was associated with a 17% increase in overall likelihood of blood clot recurrence

People with metabolic syndrome are more likely to experience recurrent venous thromboembolism (VTE), according to researchers from Indiana University School of Medicine's Department of Emergency Medicine. Patients diagnosed with deep vein thrombosis (DVT) who also had markers of metabolic syndrome were more likely to experience another VTE event – and as the number of metabolic syndrome conditions that the patients exhibited increased, so too did their likelihood of experiencing VTE recurrence.

The study, ‘Metabolic syndrome increases risk of venous thromboembolism recurrence after acute deep vein thrombosis’, published in Blood Advances, is the largest study of DVT patients to date to show that metabolic syndrome plays an important role in VTE recurrence.

Using a statewide database, the researchers used data from the Indiana Network for Patient Care, to analyse 151,054 patients diagnosed with DVT between 2004-2017. They examined four metabolic syndrome components - hypertension, hyperlipidaemia, diabetes and obesity - and found that 68% of DVT patients had also been diagnosed with at least one of those conditions. The presence of comorbid metabolic syndrome was associated with a 17% increase in overall likelihood of blood clot recurrence.

The study also showed that the risk of subsequent blood clots increased with each additional metabolic syndrome component: patients without any of the four markers for metabolic syndrome had a VTE recurrence rate of 7%. Those patients who had been diagnosed with one component of metabolic syndrome were found to be at a 14% risk of additional blood clots, followed by 21% risk among patients with two components, 30% for those with three components, and 37% for those diagnosed with all four components.

"Our aim was to improve understanding of the effect of metabolic syndrome on blood clot recurrence," said the study's first author, Dr Lauren K Stewart of the Indiana University School of Medicine's Department of Emergency Medicine. "If patients have VTE recurrence, their quality of life drops, and it drops a lot. We wanted to investigate possible comorbidities and factors that affect recurrence so we could stimulate research into new potential treatments."

The researchers suggest that addressing comorbid metabolic syndrome conditions among DVT patients may alleviate or prevent some of the harmful effects of VTE recurrence.

"This study underscores the need for further research into co-treating metabolic syndrome in addition to prescribing anticoagulants," said added Stewart. "Physicians may now want to consider checking other boxes—is the patient's hypertension being addressed? Is the hyperlipidaemia, the glucose intolerance? Have I talked to the patient about exercise and diet?"

Another interesting finding involved the role of anticoagulant therapy: the researchers found that although patients who had been diagnosed with both DVT and metabolic syndrome had higher documented rates and duration of anticoagulant use, the link between metabolic syndrome and increased risk of VTE recurrence persisted. This suggests that metabolic syndrome may have an even greater effect on VTE risk than observed, and that the effect may have been minimized due to anticoagulant therapy.

Ultimately, the researchers hope their findings will empower patients and physicians to work together to address the tie between VTE and metabolic syndrome.

"Having one or more of these conditions of obesity, hyperlipidaemia, hypertension, or diabetes creates a worse outcome for patients with blood clots. But the good news is, all four of these conditions can be treated and modified," concluded Stewart.

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