Influence of age and BMI on risk of venous thromboembolism: a pooled analysis of 246,513 women using combined oral contraceptives based on 521,516 women-years.
ESC Congress Library. Barnett C. 05/11/18; 208267; ESC260
Dr. Clare Barnett
Dr. Clare Barnett
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Background:  Women experiencing VTE under COC use often have multiple predisposing factors including advancing age and obesity. The independent effects of obesity and age have been previously reported, however, it is not known if these two factors have a multiplicative effect.  Objectives:  To determine if age and BMI interact when modelling the risk of VTE among users of combined oral contraceptives. Methods: Meta-analysis of five prospective, observational cohort studies with primary endpoints of venous thromboembolism in women using COCs (IOC, TASC, ISCO, IFOC, LASS) were included.  All studies were conducted between 2007 and 2016 by our team using a similar methodology. ISCO and IFOC are ongoing prospective cohorts with study end dates of 2015 and 2016. 246,513 women with an observation time of 521,516 women-years were included. Inclusion criteria for all studies was prescription of a new COC, with no specific exclusion criteria.  Studies were conducted across Europe and the United States. All women were followed for 3-5 years. Age categorization was 40 years. BMI was defined dichotomously: 35 kg/m2.  Cofactors included in final analysis included smoking (y/n) and family history. Poisson and Cox regression models were used to show the effect of age and BMI on VTE risk.  Adjustments were made for smoking and family history. The relative risk due to interaction (RERI) was calculated as described by Li et al. (2007). Interaction was defined as departure from the additive model (RERI = HR11 - HR10 - HR01 + 1). A RERI>0 or Results:  Poisson and Cox regression models show significant independent effects of age and BMI on VTE risk. Increasing age (ordinal scaled) was significantly associated with an increased VTE risk. The HR was observed between 1.15 and 1.70. The HR of BMI ranged from 1.06 to 5.11. Results of the meta-analysis point to a strong homogeneous effect of both factors HR(age) = 1.55 (1.44-1.68) and HR(BMI) = 2.09 (1.53-2.87).  We observed a positive value for RERI in almost all categories tested, but significance based on normal approximation (χ2 test) could not be determined. Conclusions: Age and BMI act as independent factors that both contribute to the risk of VTE. Their effect is additive, with no positive or negative interaction.
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