Relationship between Body Mass Index, Risk of Venous thromboembolism and Pulmonary Embolism: a systematic review and dose-response meta-analysis of cohort studies among four million participants

Jamal Rahmani, Arezoo Haghighian Roudsari, Hiba Bawadi, Jacqueline Thomps, Razieh Khalooei Fard, Cain Clark, Paul Ryan, Marjan Ajami, Fatemeh Rahimi sakak, Ammar Salehisahlabadi, Hebatullah M Abdulazeem, Mohammad Reza Jamali, Jalaledin Mirzay Razaz

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Background: The relationship between Body Mass Index (BMI) and Risk of Venous thromboembolism (VTE) and Pulmonary Embolism (PE) is a controversial issue. This dose-response meta-analysis was performed to investigate the association between BMI and risk of VTE and PE incidence based on cohort studies. Method: A comprehensive systematic search was conducted up to August 2019 in MEDLINE/PubMed, SCOPUS, and Cochrane. DerSimonian and Laird random-effects models were run to estimate combined hazard ratios (HRs) with 95% confidence intervals (CIs). Dose-response analysis was also carried out based on BMI values. Results: Eleven articles with 16 arms and 3,910,747 participants were eligible for inclusion in this systematic review and meta-analysis. Pooled results showed a positive association between BMI and risk of VTE in the obese participants compared to participants classified in the normal BMI category (HR: 1.62, 95% CI: 1.29 -2.04, I2=95%). Furthermore, results showed a significant association between lower BMI (underweight versus normal BMI category) and reduced risk of PE (HR: 0.80, 95% CI: 0.70 -0.92, I2=9%) and higher risk of PE in obese versus normal BMI participants (HR: 2.24, 95% CI: 1.93 -2.60, I2=0%). There was a significant linear relationship between BMI and risk of VTE (p<0.001) and PE (p<0.001). Conclusions: This systematic review and dose-response meta-analysis with 3,910,747 participants highlights obesity as a significant risk factor related to the incidence of VTE and PE. Keywords: Body Mass Index; Venous thromboembolism; Pulmonary Embolism.
Original languageEnglish
Pages (from-to)(In-Press)
JournalThrombosis Research
Publication statusAccepted/In press - 9 May 2020


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