Protein C, antithrombin, and venous thromboembolism incidence: A prospective population-based study

Aaron R. Folsom, Nena Aleksic, Lu Wang, Mary Cushman, Kenneth K. Wu, Richard H White

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Although deficiencies of protein C and antithrombin, 2 natural plasma anticoagulants, are known risk factors for venous thrombosis, population-based prospective incidence data on these associations are lacking. Venous thromboembolic events have been identified in adults in 2 longitudinal cohort studies, the Atherosclerosis Risk in Communities (ARIC) Study and the Cardiovascular Health Study (CHS). Incidence was examined in relation to prediagnostic plasma levels of protein C (ARIC Study only) and antithrombin. Over a mean of 8.1 years of follow-up, there were 130 incident venous thromboembolic events that were not due to cancer in the ARIC Study. The age-adjusted incidence was elevated 3.36-fold (95% CI 1.24 to 9.11) in the 1.1% of subjects with protein C values <2.0 mg/L compared with subjects with higher values. In contrast, in the ARIC Study and the CHS, there was no association between low plasma antithrombin and venous thromboembolism. In conclusion, in this population-based study, a low protein C, but not antithrombin, level has been determined to be associated with an increased incidence of venous thromboembolism. Attributable risk estimates suggest that low protein C levels account for ≈2.5% of venous thromboembolic events in the ARIC population.

Original languageEnglish (US)
Pages (from-to)1018-1022
Number of pages5
JournalArteriosclerosis, Thrombosis, and Vascular Biology
Volume22
Issue number6
DOIs
StatePublished - 2002
Externally publishedYes

Fingerprint

Antithrombins
Venous Thromboembolism
Protein C
Atherosclerosis
Incidence
Population
Protein C Deficiency
Health
Venous Thrombosis
Anticoagulants
Longitudinal Studies
Blood Proteins
Cohort Studies
Neoplasms

Keywords

  • Antithrombin
  • Prospective study
  • Protein C
  • Pulmonary embolus
  • Venous thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Protein C, antithrombin, and venous thromboembolism incidence : A prospective population-based study. / Folsom, Aaron R.; Aleksic, Nena; Wang, Lu; Cushman, Mary; Wu, Kenneth K.; White, Richard H.

In: Arteriosclerosis, Thrombosis, and Vascular Biology, Vol. 22, No. 6, 2002, p. 1018-1022.

Research output: Contribution to journalArticle

Folsom, Aaron R. ; Aleksic, Nena ; Wang, Lu ; Cushman, Mary ; Wu, Kenneth K. ; White, Richard H. / Protein C, antithrombin, and venous thromboembolism incidence : A prospective population-based study. In: Arteriosclerosis, Thrombosis, and Vascular Biology. 2002 ; Vol. 22, No. 6. pp. 1018-1022.
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abstract = "Although deficiencies of protein C and antithrombin, 2 natural plasma anticoagulants, are known risk factors for venous thrombosis, population-based prospective incidence data on these associations are lacking. Venous thromboembolic events have been identified in adults in 2 longitudinal cohort studies, the Atherosclerosis Risk in Communities (ARIC) Study and the Cardiovascular Health Study (CHS). Incidence was examined in relation to prediagnostic plasma levels of protein C (ARIC Study only) and antithrombin. Over a mean of 8.1 years of follow-up, there were 130 incident venous thromboembolic events that were not due to cancer in the ARIC Study. The age-adjusted incidence was elevated 3.36-fold (95{\%} CI 1.24 to 9.11) in the 1.1{\%} of subjects with protein C values <2.0 mg/L compared with subjects with higher values. In contrast, in the ARIC Study and the CHS, there was no association between low plasma antithrombin and venous thromboembolism. In conclusion, in this population-based study, a low protein C, but not antithrombin, level has been determined to be associated with an increased incidence of venous thromboembolism. Attributable risk estimates suggest that low protein C levels account for ≈2.5{\%} of venous thromboembolic events in the ARIC population.",
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