Current and Former Smoking and Risk for Venous Thromboembolism: A Systematic Review and Meta-Analysis
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{"title"=>"Current and Former Smoking and Risk for Venous Thromboembolism: A Systematic Review and Meta-Analysis", "type"=>"journal", "authors"=>[{"first_name"=>"Yun-Jiu", "last_name"=>"Cheng"}, {"first_name"=>"Zhi-Hao", "last_name"=>"Liu"}, {"first_name"=>"Feng-Juan", "last_name"=>"Yao"}, {"first_name"=>"Wu-Tao", "last_name"=>"Zeng"}, {"first_name"=>"Dong-Dan", "last_name"=>"Zheng"}, {"first_name"=>"Yu-Gang", "last_name"=>"Dong"}, {"first_name"=>"Su-Hua", "last_name"=>"Wu"}], "year"=>2013, "source"=>"PLoS Medicine", "identifiers"=>{"issn"=>"1549-1676", "doi"=>"10.1371/journal.pmed.1001515", "pmid"=>"24068896", "isbn"=>"1549-1676"}, "id"=>"a9bf7ce5-694c-318c-9884-1ca4f2f67270", "abstract"=>"BACKGROUND Smoking is a well-established risk factor for atherosclerotic disease, but its role as an independent risk factor for venous thromboembolism (VTE) remains controversial. We conducted a meta-analysis to summarize all published prospective studies and case-control studies to update the risk for VTE in smokers and determine whether a dose-response relationship exists. METHODS AND FINDINGS We performed a literature search using MEDLINE (source PubMed, January 1, 1966 to June 15, 2013) and EMBASE (January 1, 1980 to June 15, 2013) with no restrictions. Pooled effect estimates were obtained by using random-effects meta-analysis. Thirty-two observational studies involving 3,966,184 participants and 35,151 VTE events were identified. Compared with never smokers, the overall combined relative risks (RRs) for developing VTE were 1.17 (95% CI 1.09-1.25) for ever smokers, 1.23 (95% CI 1.14-1.33) for current smokers, and 1.10 (95% CI 1.03-1.17) for former smokers, respectively. The risk increased by 10.2% (95% CI 8.6%-11.8%) for every additional ten cigarettes per day smoked or by 6.1% (95% CI 3.8%-8.5%) for every additional ten pack-years. Analysis of 13 studies adjusted for body mass index (BMI) yielded a relatively higher RR (1.30; 95% CI 1.24-1.37) for current smokers. The population attributable fractions of VTE were 8.7% (95% CI 4.8%-12.3%) for ever smoking, 5.8% (95% CI 3.6%-8.2%) for current smoking, and 2.7% (95% CI 0.8%-4.5%) for former smoking. Smoking was associated with an absolute risk increase of 24.3 (95% CI 15.4-26.7) cases per 100,000 person-years. CONCLUSIONS Cigarette smoking is associated with a slightly increased risk for VTE. BMI appears to be a confounding factor in the risk estimates. The relationship between VTE and smoking has clinical relevance with respect to individual screening, risk factor modification, and the primary and secondary prevention of VTE. Please see later in the article for the Editors' Summary.", "link"=>"http://www.mendeley.com/research/current-former-smoking-risk-venous-thromboembolism-systematic-review-metaanalysis-2", "reader_count"=>49, "reader_count_by_academic_status"=>{"Unspecified"=>1, "Professor > Associate Professor"=>3, "Researcher"=>6, "Student > Doctoral Student"=>5, "Student > Ph. D. Student"=>9, "Student > Postgraduate"=>3, "Student > Master"=>11, "Other"=>8, "Lecturer"=>1, "Lecturer > Senior Lecturer"=>2}, "reader_count_by_user_role"=>{"Unspecified"=>1, "Professor > Associate Professor"=>3, "Researcher"=>6, "Student > Doctoral Student"=>5, "Student > Ph. D. Student"=>9, "Student > Postgraduate"=>3, "Student > Master"=>11, "Other"=>8, "Lecturer"=>1, "Lecturer > Senior Lecturer"=>2}, "reader_count_by_subject_area"=>{"Unspecified"=>4, "Environmental Science"=>1, "Biochemistry, Genetics and Molecular Biology"=>4, "Nursing and Health Professions"=>3, "Mathematics"=>1, "Medicine and Dentistry"=>28, "Agricultural and Biological Sciences"=>4, "Business, Management and Accounting"=>1, "Social Sciences"=>3}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>28}, "Social Sciences"=>{"Social Sciences"=>3}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>4}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>3}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>1}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>4}, "Mathematics"=>{"Mathematics"=>1}, "Unspecified"=>{"Unspecified"=>4}, "Environmental Science"=>{"Environmental Science"=>1}}, "reader_count_by_country"=>{"Canada"=>2, "Netherlands"=>1, "Egypt"=>1, "Denmark"=>1, "Germany"=>1}, "group_count"=>8}

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Figshare

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  • {"files"=>["https://ndownloader.figshare.com/files/1206659"], "description"=>"<p>(A–C) Funnel plots showing associations of smoking with VTE.</p>", "links"=>[], "tags"=>["funnel", "associations", "smoking"], "article_id"=>801153, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Yun-Jiu Cheng", "Zhi-Hao Liu", "Feng-Juan Yao", "Wu-Tao Zeng", "Dong-Dan Zheng", "Yu-Gang Dong", "Su-Hua Wu"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1001515.g003"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_A_8211_C_Funnel_plots_showing_associations_of_smoking_with_VTE_/801153", "title"=>"(A–C) Funnel plots showing associations of smoking with VTE.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-09-17 01:33:09"}
  • {"files"=>["https://ndownloader.figshare.com/files/1206661"], "description"=>"<p>The size of each square is proportional to the study's weight (inverse of variance). Cardiovascular risk factors (BCDHAP): B, BMI, body weight or waist circumference; C, cholesterol; D, diabetes; H, hypertension; A, alcohol consumption; P, physical activity. For example, Sweetland S 2013 adjusted for body mass index, diabetes, hypertension, alcohol consumption, physical activity, and three other non-cardiovascular risk factors, but not for cholesterol.</p>", "links"=>[], "tags"=>["factor-adjusted"], "article_id"=>801155, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Yun-Jiu Cheng", "Zhi-Hao Liu", "Feng-Juan Yao", "Wu-Tao Zeng", "Dong-Dan Zheng", "Yu-Gang Dong", "Su-Hua Wu"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1001515.g004"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Cardiovascular_risk_factor_adjusted_relative_risk_for_VTE_/801155", "title"=>"Cardiovascular risk factor-adjusted relative risk for VTE.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-09-17 01:33:09"}
  • {"files"=>["https://ndownloader.figshare.com/files/1206662"], "description"=>"<p>The solid line represents point estimates of association between tobacco consumption and VTE risk; dashed lines are 95% CIs. Circles present the dose-specific RR estimates reported in each study. The area of each circle is proportional to the inverse variance of the RR. The dotted line represents the null hypothesis of no association. The vertical axis is on a log scale.</p>", "links"=>[], "tags"=>["dose-response", "vte", "incidence", "cigarettes", "pack-years", "explanatory"], "article_id"=>801156, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Yun-Jiu Cheng", "Zhi-Hao Liu", "Feng-Juan Yao", "Wu-Tao Zeng", "Dong-Dan Zheng", "Yu-Gang Dong", "Su-Hua Wu"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1001515.g005"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Linear_dose_response_relationship_between_relative_risk_of_VTE_incidence_and_tobacco_consumption_with_cigarettes_per_day_A_and_pack_years_B_as_the_explanatory_variables_/801156", "title"=>"Linear dose-response relationship between relative risk of VTE incidence and tobacco consumption with cigarettes per day (A) and pack-years (B) as the explanatory variables.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-09-17 01:33:09"}
  • {"files"=>["https://ndownloader.figshare.com/files/1206663"], "description"=>"<p>BMI calculated as weight in kilograms divided by height in meters squared.</p>a<p>Adjusted estimates were reported for men and women separately and together. If all three types of estimates were reported (M, W, B), they were analyzed separately by sex only in the heterogeneity analysis for sex.</p>b<p>The term “other” in the “Variables adjusted for” column stands for all the adjusting variables other than age, sex, and cardiovascular risk factors (BCDHAP: B, BMI, body weight, waist circumference; C, cholesterol; D, diabetes; H, hypertension; A, alcohol consumption; P, physical activity).</p>c<p>Median.</p>", "links"=>[], "tags"=>["studies", "incidence"], "article_id"=>801157, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Yun-Jiu Cheng", "Zhi-Hao Liu", "Feng-Juan Yao", "Wu-Tao Zeng", "Dong-Dan Zheng", "Yu-Gang Dong", "Su-Hua Wu"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1001515.t001"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Cohort_studies_reporting_incidence_risk_estimates_/801157", "title"=>"Cohort studies reporting incidence risk estimates.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-09-17 01:33:09"}
  • {"files"=>["https://ndownloader.figshare.com/files/1206664"], "description"=>"a<p><i>p</i>-Value for I<sup>2</sup>.</p>b<p>Studies reporting estimates that adjusted for at least one confounding factor.</p>c<p>Large prospective cohort studies with sample size over 15,000.</p>d<p>Studies with population over 1 million by Hippisley-Cox J and Sweetland S <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001515#pmed.1001515-HippisleyCox1\" target=\"_blank\">[26]</a>,<a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001515#pmed.1001515-Sweetland1\" target=\"_blank\">[29]</a>.</p>e<p>Studies with largest RR by Dreyer NA for ever smokers, by Hansson PO for current smokers and by Zhu J for former smokers <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001515#pmed.1001515-Hansson1\" target=\"_blank\">[20]</a>,<a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001515#pmed.1001515-Dreyer1\" target=\"_blank\">[30]</a>,<a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001515#pmed.1001515-Zhu1\" target=\"_blank\">[43]</a>.</p>", "links"=>[], "tags"=>["heterogeneity", "pooled", "risks", "vte"], "article_id"=>801158, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Yun-Jiu Cheng", "Zhi-Hao Liu", "Feng-Juan Yao", "Wu-Tao Zeng", "Dong-Dan Zheng", "Yu-Gang Dong", "Su-Hua Wu"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1001515.t003"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Sensitivity_and_heterogeneity_analysis_of_pooled_relative_risks_of_VTE_for_smokers_/801158", "title"=>"Sensitivity and heterogeneity analysis of pooled relative risks of VTE for smokers.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-09-17 01:33:09"}
  • {"files"=>["https://ndownloader.figshare.com/files/1206665"], "description"=>"<p>BMI, calculated as weight in kilograms divided by height in meters squared.</p>a<p>Adjusted estimates were reported for men and women separately and together. If all three types of estimates were reported (M, W, B), they were analyzed separately by sex only in the heterogeneity analysis for sex.</p>b<p>The term “other” in the “Variables adjusted for” column stands for all the adjusting variables other than age, sex and cardiovascular risk factors (BCDHAP: B, BMI, body weight, waist circumference; C, cholesterol; D, diabetes; H, hypertension; A, alcohol consumption; P, physical activity).</p>", "links"=>[], "tags"=>["studies", "incidence"], "article_id"=>801159, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Yun-Jiu Cheng", "Zhi-Hao Liu", "Feng-Juan Yao", "Wu-Tao Zeng", "Dong-Dan Zheng", "Yu-Gang Dong", "Su-Hua Wu"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1001515.t002"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Case_control_studies_reporting_incidence_risk_estimates_/801159", "title"=>"Case-control studies reporting incidence risk estimates.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-09-17 01:33:09"}
  • {"files"=>["https://ndownloader.figshare.com/files/1206666"], "description"=>"a<p><i>p</i>-Values test homogeneity between strata.</p>b<p>Levels of adjustment in multivariate models: −, not adjusted for any confounding factors; +, adjusted for conventional confounding factors (i.e., age, sex); ++, further adjusted by potential cardiovascular risk factors (BCDHAP: B, BMI, body weight, circumference; C, cholesterol; D, diabetes; H, hypertension; A, alcohol consumption; P, physical activity. BMI, body weight or circumference was adjusted in every study).</p>c<p>Studies could contribute to one or both estimates depending on design of the primary studies.</p>", "links"=>[], "tags"=>["pooled", "risks", "vte", "smokers", "heterogeneity"], "article_id"=>801160, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Yun-Jiu Cheng", "Zhi-Hao Liu", "Feng-Juan Yao", "Wu-Tao Zeng", "Dong-Dan Zheng", "Yu-Gang Dong", "Su-Hua Wu"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1001515.t004"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Stratified_analysis_of_pooled_relative_risks_of_VTE_for_smokers_and_heterogeneity_analysis_a_/801160", "title"=>"Stratified analysis of pooled relative risks of VTE for smokers and heterogeneity analysis<sup>a</sup>.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-09-17 01:33:09"}
  • {"files"=>["https://ndownloader.figshare.com/files/1206675", "https://ndownloader.figshare.com/files/1206676", "https://ndownloader.figshare.com/files/1206677", "https://ndownloader.figshare.com/files/1206678", "https://ndownloader.figshare.com/files/1206679", "https://ndownloader.figshare.com/files/1206680", "https://ndownloader.figshare.com/files/1206681"], "description"=>"<div><p>Background</p><p>Smoking is a well-established risk factor for atherosclerotic disease, but its role as an independent risk factor for venous thromboembolism (VTE) remains controversial. We conducted a meta-analysis to summarize all published prospective studies and case-control studies to update the risk for VTE in smokers and determine whether a dose–response relationship exists.</p><p>Methods and Findings</p><p>We performed a literature search using MEDLINE (source PubMed, January 1, 1966 to June 15, 2013) and EMBASE (January 1, 1980 to June 15, 2013) with no restrictions. Pooled effect estimates were obtained by using random-effects meta-analysis. Thirty-two observational studies involving 3,966,184 participants and 35,151 VTE events were identified. Compared with never smokers, the overall combined relative risks (RRs) for developing VTE were 1.17 (95% CI 1.09–1.25) for ever smokers, 1.23 (95% CI 1.14–1.33) for current smokers, and 1.10 (95% CI 1.03–1.17) for former smokers, respectively. The risk increased by 10.2% (95% CI 8.6%–11.8%) for every additional ten cigarettes per day smoked or by 6.1% (95% CI 3.8%–8.5%) for every additional ten pack-years. Analysis of 13 studies adjusted for body mass index (BMI) yielded a relatively higher RR (1.30; 95% CI 1.24–1.37) for current smokers. The population attributable fractions of VTE were 8.7% (95% CI 4.8%–12.3%) for ever smoking, 5.8% (95% CI 3.6%–8.2%) for current smoking, and 2.7% (95% CI 0.8%–4.5%) for former smoking. Smoking was associated with an absolute risk increase of 24.3 (95% CI 15.4–26.7) cases per 100,000 person-years.</p><p>Conclusions</p><p>Cigarette smoking is associated with a slightly increased risk for VTE. BMI appears to be a confounding factor in the risk estimates. The relationship between VTE and smoking has clinical relevance with respect to individual screening, risk factor modification, and the primary and secondary prevention of VTE.</p><p><i>Please see later in the article for the Editors' Summary</i></p></div>", "links"=>[], "tags"=>["smoking", "venous", "systematic"], "article_id"=>801169, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Yun-Jiu Cheng", "Zhi-Hao Liu", "Feng-Juan Yao", "Wu-Tao Zeng", "Dong-Dan Zheng", "Yu-Gang Dong", "Su-Hua Wu"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1001515.s001", "https://dx.doi.org/10.1371/journal.pmed.1001515.s002", "https://dx.doi.org/10.1371/journal.pmed.1001515.s003", "https://dx.doi.org/10.1371/journal.pmed.1001515.s004", "https://dx.doi.org/10.1371/journal.pmed.1001515.s005", "https://dx.doi.org/10.1371/journal.pmed.1001515.s006", "https://dx.doi.org/10.1371/journal.pmed.1001515.s007"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Current_and_Former_Smoking_and_Risk_for_Venous_Thromboembolism_A_Systematic_Review_and_Meta_Analysis_/801169", "title"=>"Current and Former Smoking and Risk for Venous Thromboembolism: A Systematic Review and Meta-Analysis", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2013-09-17 01:33:09"}

PMC Usage Stats | Further Information

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Relative Metric

{"start_date"=>"2013-01-01T00:00:00Z", "end_date"=>"2013-12-31T00:00:00Z", "subject_areas"=>[{"subject_area"=>"/Biology and life sciences", "average_usage"=>[269, 466, 588, 697, 800, 896, 988, 1076, 1165, 1254, 1340, 1417]}, {"subject_area"=>"/Biology and life sciences/Behavior", "average_usage"=>[306, 490, 611, 718, 817, 916, 999, 1091, 1185, 1258, 1341, 1412, 1476]}, {"subject_area"=>"/Biology and life sciences/Nutrition", "average_usage"=>[264, 463, 602, 708, 816, 908, 1015, 1103, 1200, 1297, 1389, 1476, 1538]}, {"subject_area"=>"/Medicine and health sciences", "average_usage"=>[264, 460, 584, 692, 794, 887, 978, 1067, 1154, 1241, 1328, 1408, 1474]}, {"subject_area"=>"/Medicine and health sciences/Metabolic disorders", "average_usage"=>[254, 466, 587, 690, 790, 885, 983, 1063, 1139, 1216, 1297, 1373, 1442]}, {"subject_area"=>"/Medicine and health sciences/Nutrition", "average_usage"=>[273, 476, 611, 714, 821, 911, 1005, 1103, 1201, 1287, 1388, 1478, 1557]}, {"subject_area"=>"/Physical sciences", "average_usage"=>[254, 431, 547, 651, 748, 842, 932, 1017, 1098, 1178, 1259, 1336, 1404]}]}
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