Diet and Incident Venous Thromboembolism: The Iowa Women's Health Study
Diet and Incident Venous Thromboembolism: The Iowa Women's Health Study
Background Little is known about the role of diet in the development of venous thromboembolism (VTE). We explored the prospective relation of dietary patterns, food groups, and nutrients to incident VTE in older women.
Methods In 1986, Iowa women aged 55 to 69 years completed a mailed survey, including a 127-item food frequency questionnaire. These data were linked to Medicare data from 1986 to 2004, and International Classification of Diseases discharge codes were used to identify hospitalized VTE cases. Cox regression analyses evaluated relations of 2 principal components–derived dietary patterns, 11 food groups, and 6 nutrients to VTE, adjusted for age, education, smoking status, physical activity, and energy intake.
Results Over 19 years of follow-up, 1,950 of the 37,393 women developed VTE. Women consuming alcohol daily were at 26% (95% CI 11%-38%) lower risk of VTE as compared to nonconsumers. All alcoholic beverages types were in the direction of lower risk; however, only beer and liquor were statistically significant. After basic adjustments, coffee was inversely related to VTE, and diet soda and fish positively related. However, these associations were confounded and became nonsignificant after adjustment for body mass index and diabetes. No associations were observed with consumption of 'Western' or 'Prudent' dietary patterns, fruit, vegetables, dairy, meat, refined grains, whole grains, regular soda, vitamins E, vitamin B6, vitamin B12, folate, ω-3 fatty acids, or saturated fat.
Conclusions In this cohort of older women, greater intake of alcohol was associated with a lower risk of incident VTE. No other independent associations were seen between diet and VTE.
Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major source of morbidity and mortality in the elderly. Diet is hypothesized to affect VTE risk by altering levels of homocysteine and coagulation factors, which have been extensively linked to the development of VTE.
However, at present, little is known about the role of dietary intake in the development of VTE. In the observational LITE study, greater consumption of a Western dietary pattern, and red and processed meat, were associated with an increased risk of validated VTE, whereas greater consumption of fruit and vegetables was associated with a decreased risk. Consumption of whole grains, refined grains, and dairy were not associated with VTE risk. Alcohol's relation to VTE has been explored in 5 studies, which have conflicting results. Two studies reported an inverse association, whereas 3 others found no relation.
The relation of nutrients to VTE risk has been evaluated more broadly. In recent results from the Women's Health Study, a significant 21% hazard reduction in risk of total VTE was observed in the group randomized to vitamin E supplementation compared to the group randomized to placebo. In LITE, VTE risk was inversely related to consumption of folate and vitamin B6. However, analogous to results from recent trials that attempted to reduce cardiovascular disease incidence by lowering homocysteine with B vitamins, trials similarly attempting to reduce VTE incidence and recurrence yielded null results. LITE observed no associations between VTE risk and intakes of saturated fatty acids and vitamin B12.
The current literature does not provide clear evidence regarding whether dietary intake influences VTE risk. Given the paucity of data, additional research is warranted. Thus, using data from the Iowa Women's Health Study (IWHS)–Medicare linkage, we conducted a comprehensive exploration of the diet-VTE relation among elderly women, using dietary patterns, multiple food groups, and selected nutrients. Based on theorized effects of diet on hemostatic factors levels, we hypothesized that consumption of a "prudent" dietary pattern, dairy, whole grains, fruit, vegetables, fish, coffee, alcohol, vitamin B6, vitamin B12, folate, vitamin E, and ω-3 fatty acids would be inversely associated with incident VTE, whereas a positive association would be observed with consumption of a Western dietary pattern, meat, refined grains, regular (sugar-sweetened) soda, diet soda, and saturated fat.
Abstract and Introduction
Abstract
Background Little is known about the role of diet in the development of venous thromboembolism (VTE). We explored the prospective relation of dietary patterns, food groups, and nutrients to incident VTE in older women.
Methods In 1986, Iowa women aged 55 to 69 years completed a mailed survey, including a 127-item food frequency questionnaire. These data were linked to Medicare data from 1986 to 2004, and International Classification of Diseases discharge codes were used to identify hospitalized VTE cases. Cox regression analyses evaluated relations of 2 principal components–derived dietary patterns, 11 food groups, and 6 nutrients to VTE, adjusted for age, education, smoking status, physical activity, and energy intake.
Results Over 19 years of follow-up, 1,950 of the 37,393 women developed VTE. Women consuming alcohol daily were at 26% (95% CI 11%-38%) lower risk of VTE as compared to nonconsumers. All alcoholic beverages types were in the direction of lower risk; however, only beer and liquor were statistically significant. After basic adjustments, coffee was inversely related to VTE, and diet soda and fish positively related. However, these associations were confounded and became nonsignificant after adjustment for body mass index and diabetes. No associations were observed with consumption of 'Western' or 'Prudent' dietary patterns, fruit, vegetables, dairy, meat, refined grains, whole grains, regular soda, vitamins E, vitamin B6, vitamin B12, folate, ω-3 fatty acids, or saturated fat.
Conclusions In this cohort of older women, greater intake of alcohol was associated with a lower risk of incident VTE. No other independent associations were seen between diet and VTE.
Introduction
Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major source of morbidity and mortality in the elderly. Diet is hypothesized to affect VTE risk by altering levels of homocysteine and coagulation factors, which have been extensively linked to the development of VTE.
However, at present, little is known about the role of dietary intake in the development of VTE. In the observational LITE study, greater consumption of a Western dietary pattern, and red and processed meat, were associated with an increased risk of validated VTE, whereas greater consumption of fruit and vegetables was associated with a decreased risk. Consumption of whole grains, refined grains, and dairy were not associated with VTE risk. Alcohol's relation to VTE has been explored in 5 studies, which have conflicting results. Two studies reported an inverse association, whereas 3 others found no relation.
The relation of nutrients to VTE risk has been evaluated more broadly. In recent results from the Women's Health Study, a significant 21% hazard reduction in risk of total VTE was observed in the group randomized to vitamin E supplementation compared to the group randomized to placebo. In LITE, VTE risk was inversely related to consumption of folate and vitamin B6. However, analogous to results from recent trials that attempted to reduce cardiovascular disease incidence by lowering homocysteine with B vitamins, trials similarly attempting to reduce VTE incidence and recurrence yielded null results. LITE observed no associations between VTE risk and intakes of saturated fatty acids and vitamin B12.
The current literature does not provide clear evidence regarding whether dietary intake influences VTE risk. Given the paucity of data, additional research is warranted. Thus, using data from the Iowa Women's Health Study (IWHS)–Medicare linkage, we conducted a comprehensive exploration of the diet-VTE relation among elderly women, using dietary patterns, multiple food groups, and selected nutrients. Based on theorized effects of diet on hemostatic factors levels, we hypothesized that consumption of a "prudent" dietary pattern, dairy, whole grains, fruit, vegetables, fish, coffee, alcohol, vitamin B6, vitamin B12, folate, vitamin E, and ω-3 fatty acids would be inversely associated with incident VTE, whereas a positive association would be observed with consumption of a Western dietary pattern, meat, refined grains, regular (sugar-sweetened) soda, diet soda, and saturated fat.
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