TY - JOUR
T1 - The risk of venous and arterial thrombosis in hyperhomocysteinaemia is low and mainly depends on concomitant thrombophilic defects
AU - Lijfering, Willem M.
AU - Coppens, Michiel
AU - van de Poel, Marlene H. W.
AU - Middeldorp, Saskia
AU - Hamulyak, Karly
AU - Bank, Ivan
AU - Veeger, Nic J. G. M.
AU - Prins, Martin H.
AU - Bueller, Harry R.
AU - van der Meer, Jan
PY - 2007
Y1 - 2007
N2 - As homocysteine-lowering treatment has not reduced the risk of recurrent thrombosis in recent clinical trials,we hypothesized that mild hyperhomocysteinaemia is an epiphenomenon or associated with a low absolute risk of thrombosis. In this retrospective study, we enrolled 478 evaluable first-degree relatives of consecutive patients with venous thrombosis or premature atherosclerosis, and hyperhomocysteinemia. Absolute risks of thrombosis and effects of concomitant thrombophilic defects were compared. Relative risks were adjusted for clustering in families, age, sex, and atherosclerotic risk factors, where appropriate. Annual incidence of venous thrombosis was 0.16% (95% confidence interval [CI], 0.08-0.30) in hyperhomocysteinemic relatives versus 0.11% (Cl, 0.05-0.20) in normohomocystei-nemic relatives; adjusted relative risk 1.6 (Cl, 0.6-4.5). Annual incidences of arterial thrombosis were 0.34% (Cl, 0.21-0.52) and 0.24% (Cl, 0.15-0.37) in hyperhomocysteinemic and normohomocysteinernic relatives, respectively; adjusted relative risk 1.5 (Cl, 0.6-3.5). Concomitance of multiple thrombophilic risk factors increased the risk of venous thrombosis in hyperhomocysteinemic relatives 20 fold, but a comparable effect was demonstrated in normohomocysteinemic relatives. We conclude that hyperhomocysteinaemia is associated with a low absolute risk of venous and arterial thrombosis. Concomitant thrombophilic defects are probably main determinants on the risk of venous thrombosis, rather than hyperhomocysteinaemia itself
AB - As homocysteine-lowering treatment has not reduced the risk of recurrent thrombosis in recent clinical trials,we hypothesized that mild hyperhomocysteinaemia is an epiphenomenon or associated with a low absolute risk of thrombosis. In this retrospective study, we enrolled 478 evaluable first-degree relatives of consecutive patients with venous thrombosis or premature atherosclerosis, and hyperhomocysteinemia. Absolute risks of thrombosis and effects of concomitant thrombophilic defects were compared. Relative risks were adjusted for clustering in families, age, sex, and atherosclerotic risk factors, where appropriate. Annual incidence of venous thrombosis was 0.16% (95% confidence interval [CI], 0.08-0.30) in hyperhomocysteinemic relatives versus 0.11% (Cl, 0.05-0.20) in normohomocystei-nemic relatives; adjusted relative risk 1.6 (Cl, 0.6-4.5). Annual incidences of arterial thrombosis were 0.34% (Cl, 0.21-0.52) and 0.24% (Cl, 0.15-0.37) in hyperhomocysteinemic and normohomocysteinernic relatives, respectively; adjusted relative risk 1.5 (Cl, 0.6-3.5). Concomitance of multiple thrombophilic risk factors increased the risk of venous thrombosis in hyperhomocysteinemic relatives 20 fold, but a comparable effect was demonstrated in normohomocysteinemic relatives. We conclude that hyperhomocysteinaemia is associated with a low absolute risk of venous and arterial thrombosis. Concomitant thrombophilic defects are probably main determinants on the risk of venous thrombosis, rather than hyperhomocysteinaemia itself
U2 - https://doi.org/10.1160/TH07-02-0138
DO - https://doi.org/10.1160/TH07-02-0138
M3 - Article
C2 - 17721631
SN - 0340-6245
VL - 98
SP - 457
EP - 463
JO - Thrombosis and haemostasis
JF - Thrombosis and haemostasis
IS - 2
ER -