Risk Factors for Venous Thromboembolism in the Comminity

描述（由申请人提供）：静脉血栓栓塞（VTE）是一个主要的国家健康问题，每年有超过275，000例事件。我们的长期目标是确定社区中VTE的流行病学。我们的具体目标是：目标1：通过更新1966-1997年至2005年12月31日明尼苏达州奥姆斯特德县首次发生DVT或肺栓塞（PE）的初始队列，扩展我们对VTE发病率趋势的分析，以检验以下假设：在最近10年期间，（1996-2005年），反映了当前的静脉血栓栓塞预防标准，静脉血栓栓塞的总体发病率没有变化，而产后妇女的PE发病率低于早期。目标二：通过5项巢式病例对照研究，检测糖尿病、高血压、高脂血症、降脂治疗、感染、3-受体阻滞剂治疗和血管紧张素转换酶（ACE）抑制剂治疗;预防的类型和持续时间（住院手术和医疗病例）;麻醉类型和持续时间（手术病例）;不动、缺乏自我保护、日常生活活动和具体疗养院位置的指标（疗养院个案）;以及肿瘤部位、肿瘤阶段、肿瘤进展、转移的存在、转移的位置和局部肿瘤侵袭的部位（癌症病例）作为VTE的独立风险因素，无论是总体（2a）还是因大手术（2b）或急性内科疾病（2c）住院的患者，被限制在疗养院的患者（2d）和癌症患者（2 e）。目标3：收集间隔历史数据，以扩展我们对VTE复发的独立预测因素的分析，包括事件和复发性VTE事件之间的中期暴露以及引入低分子量肝素治疗（LMWH）对VTE复发风险的影响。这些数据将提供关于新的预防药物对VTE发病率的影响以及为什么一些但不是大多数高危患者发生VTE的见解，并测试门诊LMWH治疗对VTE复发的影响。

DESCRIPTION (provided by applicant): Venous thromboembolism (VTE) is a major national health problem, with over 275,000 incident cases annually. Our long-term objective is to determine the epidemiology of VTE in the community. Our specific aims are: Aim 1: To extend our analysis of trends in the incidence of VTE by updating our Olmsted County, MN inception cohort with a first lifetime DVT or pulmonary embolism (PE) from 1966-1997 through 12/31/2005 in order to test the hypotheses that, over the most recent 10-year period (1996-2005) which reflects the current standard of VTE prophylaxis, the overall incidence of VTE is unchanged while the incidence of PE among postpartum women is lower compared to earlier periods. Aim 2: To continue our comprehensive analysis of risk factors for VTE by performing 5 nested case-control studies to test diabetes mellitus, hypertension, hyperlipidemia, lipid lowering therapy, infection, (3-blocker therapy and angiotensin-converting enzyme (ACE) inhibitor therapy; type and duration of prophylaxis (hospitalized surgery and medical cases); type and duration of anesthesia (surgery cases); indicators of immobility, lack of self-preservation, activities of daily living and specific nursing home location (nursing home cases); and tumor site, tumor stage, tumor progression, presence of metastases, location of metastases, and site of local tumor invasion (cancer cases) as independent risk factors for VTE, both overall (2a) as well as among patients hospitalized for major surgery (2b) or acute medical illness (2c), patients confined to a nursing home (2d), and cancer patients (2e). Aim 3: To collect interval history data in order to extend our analysis of independent predictors of VTE recurrence to include the effects of interim exposures between the incident and recurrent VTE events, and the introduction of low molecular weight heparin therapy (LMWH), on the hazard of VTE recurrence. This data will provide insights regarding the effect of new prophylaxis drugs on VTE incidence and why some but not most high-risk patients develop VTE, and test the effect of outpatient LMWH therapy on VTE recurrence.