Body Height and Risk of Venous Thromboembolism: The Tromsø Study
The Troms Study
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Sigrid K. Braekkan
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Knut H. Borch
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Ellisiv B. Mathiesen
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Inger Njlstad
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Tom Wilsgaard
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John-Bjarne Hansen
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Institute of Clinical Medicine, University of Troms
, N-9037 Troms,
Norway (
American Journal of Epidemiology The Author 2010. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: . An association between body height and venous thromboembolism (VTE) has been suggested by previous studies including males only. The aim of this prospective cohort study was to investigate the sex-specific impact of body height on risk of VTE in a general population. Risk factors, including body height and weight, were registered for 26,727 subjects aged 25-96 years who participated in the Troms Study (Norway) in 1994-1995. Incident VTE events were registered through September 1, 2007. There were 462 VTE events during a median 12.5 years of follow-up. Body height was a risk factor for VTE in men, but not in women. Multivariable hazard ratios per 10 cm, adjusted for age, body mass index, diabetes, smoking, and hormone therapy (women), were 1.34 (95% confidence interval: 1.09, 1.64) for men and 1.13 (95% confidence interval: 0.91, 1.40) for women. Hazard ratios by quartiles of body height revealed that men in the upper quartile (>181 cm) had a 1.99-fold (95% confidence interval: 1.35, 2.92) increased risk of VTE compared with men in the lowest quartile (<173 cm) (P for trend across quartiles 0.002). There was no significant trend (P 0.2) across quartiles of body height for women. Study findings revealed that body height is a sex-specific risk factor for VTE in men. body height; risk factors; venous thromboembolism Abbreviations: CI, confidence interval; HR, hazard ratio; VTE, venous thromboembolism.
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Venous thromboembolism (VTE), including deep vein
thrombosis and pulmonary embolism, is a common
multifactor disease, with serious short-term and long-term
complications and a potentially fatal outcome (1). The annual
incidence is approximately 13 per 1,000 adults in
developed countries (1, 2), and VTE is the third most common
cardiovascular disease (3, 4). Even though surgery, trauma,
hospitalization, malignancy, immobilization, pregnancy, use
of estrogens, and inherited thrombophilia are associated
with VTE events (1, 5), 30%50% of the events still are
not associated with obvious predisposing factors (6, 7).
Several investigations have consistently shown that
anthropometric measures of obesity, such as body mass index
and waist circumference, are strong and independent risk
factors for VTE in population-based studies (810), in
outpatients (11), and in patients discharged from hospitals (12).
In contrast, the impact of other anthropometric measures,
such as body height, on risk of VTE has received little
attention. In the mid-19th century, Virchow acknowledged
blood stasis as a major contributor to venous thrombosis
(13), and body height was later shown to affect venous
pressure dynamics (14, 15). Thus, it is likely that body
height may affect risk of VTE.
Data from the Physicians Health Study (3), including
only male physicians, showed that taller men had an
increased risk of VTE. Similar findings were reported in a
cohort of Swedish men (16). To the best of our knowledge, no
study has addressed the sex-specific impact of body height
on risk of VTE. Thus, we wanted to investigate whether
body height was an independent risk factor for VTE in
men and women. To address this question, we performed
a prospective, population-based study of 26,727 adults, of
whom 47.5% were males, and assessed the impact of body
height on the incidence of VTE in sex-stratified analysis.
MATERIALS AND METHODS
Study population
Participants were recruited from the fourth survey of
the Troms Study (conducted in 19941995), a
singlecenter, prospective, population-based study with repeated
health surveys of inhabitants of Troms, Norway. All
inhabitants older than age 24 years were invited, and 27,158
participated (77% of the eligible population). Data were
collected by physical examination, blood samples, and
self-administered questionnaires. The study was approved
by the regional committee for research ethics, and all
participants gave their informed, written consent. Subjects who
did not consent to medical research (n 300) and those not
officially registered as inhabitants of the municipality of
Troms (n 43) were excluded from the study.
Furthermore, subjects with a known history of VTE (n 47) and
those with missing values for body height (n 41) were
excluded. Therefore, 26,727 subjects were included in our
study. Incident VTE events among the study participants
were recorded from the date of enrollment through the
end of follow-up, September 1, 2007.
Baseline measurements
Body height and weight were measured with subjects
wearing light clothing and no shoes. Height was measured
to the nearest centimeter and wei (...truncated)