Full Length ArticleCardiovascular disease and mortality after a first episode of venous thromboembolism in young and middle-aged women

•Women with a previous VTE had increased risk of CVD and overall mortality.•The risk estimates only changed modestly when adjusting for cardiovascular risk factors.•The risk of CVD and MI is highest for women with unprovoked VTE or PE.•The study is a cohort study on women 18-64 years of age in Sweden.

BackgroundPatients with a history of venous thromboembolism (VTE) seem to have an increased risk of arterial cardiovascular disease (CVD).ObjectivesTo evaluate the risk of CVD and overall mortality after a first episode of VTE in women and to assess common risk factors for VTE and CVD.Patients/methodsWe performed a cohort study inviting 1433 women with a previous VTE (exposed) and 1402 women without VTE (unexposed). The cohort was derived from TEHS, a Swedish population-based case-control study on risk factors for VTE in women age 18-64 years. The women were recruited in 2002-2009. During 2011 information on CVD and mortality was obtained from a questionnaire and from the Swedish Patient Register and the Cause of Death Register. Hazard ratios (HR) for CVD and their 95% confidence intervals (CI) were calculated using Cox regression. In multivariate analyses we adjusted for age, smoking, diabetes mellitus, hypertension and body mass index.Results2108 (75%) women (mean age 47 ± 13 years) accepted participation. During the total follow up of 11,920 person years 35 (3.2%, 95% CI 0.7-2.1) among the exposed and 14 (1.4%, 95% CI 0.2-4.3) among the unexposed had any CVD event. The adjusted HR for CVD was 2.0 (95% CI 1.1-3.9) the adjusted HR for mortality was 2.3 (95% CI 1.2-4.6)ConclusionWomen with a previous VTE had a two-fold increased risk of CVD and overall mortality. Adjusting for cardiovascular risk factors only modestly changed the estimates.