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Original Investigation |

Risk of Cerebral Venous Thrombosis in Obese Women

Susanna M. Zuurbier, MD1; Marcel Arnold, MD, PhD2; Saskia Middeldorp, MD, PhD3; Anne Broeg-Morvay, MD2; Suzanne M. Silvis, MD1; Mirjam R. Heldner, MD2; Julia Meisterernst, MD2; Banne Nemeth, MD4; Eva R. Meulendijks, BSc1; Jan Stam, MD, PhD1; Suzanne C. Cannegieter, MD, PhD4; Jonathan M. Coutinho, MD, PhD1,5
[+] Author Affiliations
1Department of Neurology, Academic Medical Centre, Amsterdam, the Netherlands
2Department of Neurology, Inselspital Hospital University, Bern, Switzerland
3Department of Vascular Medicine, Academic Medical Centre, Amsterdam, the Netherlands
4Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
5Division of Neuroradiology, Department of Medical Imaging, University Health Network and the University of Toronto, Toronto, Ontario, Canada
JAMA Neurol. 2016;73(5):579-584. doi:10.1001/jamaneurol.2016.0001.
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Importance  Obesity is a risk factor for deep vein thrombosis of the leg and pulmonary embolism. To date, however, whether obesity is associated with adult cerebral venous thrombosis (CVT) has not been assessed.

Objective  To assess whether obesity is a risk factor for CVT.

Design, Setting, and Participants  A case-control study was performed in consecutive adult patients with CVT admitted from July 1, 2006 (Amsterdam), and October 1, 2009 (Berne), through December 31, 2014, to the Academic Medical Center in Amsterdam, the Netherlands, or Inselspital University Hospital in Berne, Switzerland. The control group was composed of individuals from the control population of the Multiple Environmental and Genetic Assessment of Risk Factors for Venous Thrombosis study, which was a large Dutch case-control study performed from March 1, 1999, to September 31, 2004, and in which risk factors for deep vein thrombosis and pulmonary embolism were assessed. Data analysis was performed from January 2 to July 12, 2015.

Main Outcomes and Measures  Obesity was determined by body mass index (BMI). A BMI of 30 or greater was considered to indicate obesity, and a BMI of 25 to 29.99 was considered to indicate overweight. A multiple imputation procedure was used for missing data. We adjusted for sex, age, history of cancer, ethnicity, smoking status, and oral contraceptive use. Individuals with normal weight (BMI <25) were the reference category.

Results  The study included 186 cases and 6134 controls. Cases were younger (median age, 40 vs 48 years), more often female (133 [71.5%] vs 3220 [52.5%]), more often used oral contraceptives (97 [72.9%] vs 758 [23.5%] of women), and more frequently had a history of cancer (17 [9.1%] vs 235 [3.8%]) compared with controls. Obesity (BMI ≥30) was associated with an increased risk of CVT (adjusted odds ratio [OR], 2.63; 95% CI, 1.53-4.54). Stratification by sex revealed a strong association between CVT and obesity in women (adjusted OR, 3.50; 95% CI, 2.00-6.14) but not in men (adjusted OR, 1.16; 95% CI, 0.25-5.30). Further stratification revealed that, in women who used oral contraceptives, overweight and obesity were associated with an increased risk of CVT in a dose-dependent manner (BMI 25.0-29.9: adjusted OR, 11.87; 95% CI, 5.94-23.74; BMI ≥30: adjusted OR, 29.26; 95% CI, 13.47-63.60). No association was found in women who did not use oral contraceptives.

Conclusions and Relevance  Obesity is a strong risk factor for CVT in women who use oral contraceptives.

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