1 - Common risk factors
Table 1
Risk factors involved in pathogenesis of both - arterial and venous thrombosis.
|
risk factor | pathogenetic mechanism | reference |
|---|---|---|
| older age | increased oxidative stress | Prandoni et al – 8 |
| increased BMI |
metabolic deterioration inflammation |
Nurses Health Study – 9 |
| hypertension |
haemodynamic stress metabolic deterioration |
Nurses Health Study – 9 |
| smoking |
damage of vessel wall oxidative stress |
Nurses Health Study – 9 |
| hypercholesterolemia | impairment of regulation of coagulation increased viscosity and erythrocyte aggregation |
Voya et al – 10 Spbieszcyk at el - 4 Libby and Simon - 5 |
In line with these arguments, is also recognition that some other nonclasical risk factors like: hyperhomocysteinemia, factor V Leiden, and lupus anticoagulants represent potential risk for both atherosclerosis and venous thrombosis.
2 - Similar or identical pathogenetic mecanism
The relationship between arterial and venous thrombosis process is also supported by the effects of measures used in prevention of atherosclerotic cardiovascular events on the prevention of venous thrombosis. For statins that are effective in the prevention of cardiovascular disease among individuals with normal or elevated levels of cholesterol, it was shown that these drugs also have antithrombotic properties (11).
In a retrospective subgroup analysis of the Heart and Estrogen Replacement Study (HERS) the use of statins was associated with a 50% risk reduction of venous thrombembolism (12). This beneficial effect of statins may be due to decreased thrombus formation mediated by their anti-inflammatory activity, suppression of the prothrombotic and endothelial-altering properties of circulating lipids and improvement of the rheological properties of the blood. Statins also seem to alter elements of the coagulation cascade consistent with an antithrombotic effect. In this study it was also first shown that long-term aspirin therapy decreased the risk of venous thrombembolism in women with established coronary artery disease (12).
3 - Associated appearance of atherosclerosis and venous thrombosis
A relation was also found between subjects with preclinical or clinical atherosclerotic disease and venous thrombembolism. Prandoni and co-workers showed that the prevalence of carotid plaques was significantly higher in patients with unexplained (primary) thrombotic events than in those with secondary ones or in age- and sex- matched subjects without thrombosis (3). This association was still present after adjustment for risk factors of atherosclerosis and thrombophilic conditions. In elderly patients, the association became even stronger. In addition, other features of atherosclerosis (such as intima-media thickness of the carotid arteries, the degree of carotid stenosis and the number of carotid segments involved) were far more frequent among subjects with spontaneous venous thrombosis. This study suggests either that atherosclerosis can induce venous thrombosis or that the two conditions share common risk factors.
In one of our studies we investigated the relation of endothelial function to VTE. Endothelial dysfunction known as one of the earliest measurable functional disturbance in atherogenesis was also detected in patients with idiopathic venous thrombosis. Patients with thrombosis had significantly lower endothelium – dependent vasodilating capability of brachial artery than heatly subjects (14).
A relationship was also found between manifested atherosclerotic disease and venous thrombembolism. In the study of Grady and co-workers, women who had myocardial infarction had a 2.1-fold higher risk of venous thrombembolism over the entire course of follow-up, but during the first 90 days after infarction, the risk was increased more than by 5-fold (12). Further, in a case-control study an association between venous thrombembolic disorders and arterial disease of the lower limbs was found (15).
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.
Conclusion:
There is evidence of an association between atherosclerotic disease and venous thrombosis. This thesis is supported by common risk factors for both diseases: older age, hyperlipidemia, hypertension, hyperhomocysteinemia, factor V Leiden, and lupus anticoagulants, by similar or identical pathogenetic mechanisms and by the association of the appearance of both diseases.
The existence of the link between arterial and venous disorders opens important new avenues for further research, including the potential role of certain drugs like statins - presently mainly used in the prevention of arterial cardiovascular disease also in management of venous thrombembolic disorders.
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