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Thromb Haemost 2013; 109(05): 891-896
DOI: 10.1160/TH12-10-0732
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

The association of smoking with venous thrombosis in women

A population-based, case-control study
Marc Blondon
1   Department of Epidemiology, University of Washington, Seattle, Washington, USA
7   Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
,
Kerri L. Wiggins
2   Department of Medicine, University of Washington, Seattle, Washington, USA
,
Barbara McKnight
3   Department of Biostatistics, University of Washington, Seattle, Washington, USA
,
Bruce M. Psaty
1   Department of Epidemiology, University of Washington, Seattle, Washington, USA
2   Department of Medicine, University of Washington, Seattle, Washington, USA
4   Department of Health Services, University of Washington, Seattle, Washington, USA
5   Group Health Research Institute, Group Health, Seattle, Washington, USA
,
Kenneth M. Rice
3   Department of Biostatistics, University of Washington, Seattle, Washington, USA
,
Susan R. Heckbert
1   Department of Epidemiology, University of Washington, Seattle, Washington, USA
5   Group Health Research Institute, Group Health, Seattle, Washington, USA
,
Nicholas L. Smith
1   Department of Epidemiology, University of Washington, Seattle, Washington, USA
5   Group Health Research Institute, Group Health, Seattle, Washington, USA
6   Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, Washington, USA
› Author Affiliations Financial support: The Heart and Vascular Health Study is supported by the National Health Lung and Blood Institute grants HL43201, HL60739, HL68986, HL73410, HL74745, HL85251, and HL95080. M. Blondon is supported by a fellowship for prospective researchers from the Swiss National Science Foundation.
Further Information

Publication History

Received: 06 October 2012

Accepted after major revision: 16 February 2013

Publication Date:
22 November 2017 (online)

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Summary

The evidence for an association between smoking and venous thrombosis (VT) is inconsistent, and its mediation pathways remain to be fully elucidated. A population-based, case-control study was conducted in a large, integrated healthcare system in Washington State, USA. Cases were women aged 18–90 years who experienced a validated incident deep-vein thrombosis or pulmonary embolism between January 1, 1995, and December 31, 2009. Controls were randomly selected from members of the healthcare system. Smoking status (current, former, never) was assessed from medical records review and, for a subset, also by telephone interview. Multivariable logistic regression was used to estimate odds ratios (OR) associated with smoking status. We identified 2,278 cases and 5,927 controls. Subjects comprised mostly postmenopausal white women with a mean age of 66 years and a current smoking prevalence of 10%. Compared to never-smokers, current and former smokers were at higher risk of VT (adjusted OR 1.21, 95% confidence interval [CI] 1.02–1.44 and OR 1.15, 95%CI 1.03–1.29, respectively). These associations were attenuated with further adjustment for potential mediators (cardiovascular disease, congestive heart failure, cancer, recent hospitalisations and physical activity): OR 1.02 (95%CI 0.83–1.25) and 0.95 (95%CI 0.83–1.08), respectively. In conclusion, the modestly increased risk of VT in women who are current or former smokers might be explained by the occurrence of smoking-related diseases and decreased physical activity. Our results do not support a direct biological effect of smoking on the risk of VT that is clinically relevant.

Note: Part of this work has been presented as a poster at the 58th annual meeting of the Scientific & Standardization Committee of the ISTH in June 2012.

Keywords

Venous thrombosis - thromboembolism - women - smoking - epidemiology
 

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