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Obesity and risk of venous thromboembolism among postmenopausal women: differential impact of hormone therapy by route of estrogen administration. The ESTHER Study
Author(s) -
CAICO M.,
OGER E.,
CONARD J.,
MEYER G.,
LÉVESQUE H.,
TRILLOT N.,
BARRELLIER M. T.,
WAHL D.,
EMMERICH J.,
SCARABIN P. Y.
Publication year - 2006
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/j.1538-7836.2006.01933.x
Subject(s) - medicine , overweight , odds ratio , body mass index , estrogen , obesity , hormone therapy , confidence interval , hormone replacement therapy (female to male) , population , menopause , breast cancer , cancer , environmental health , testosterone (patch)
Summary. Background: Oral estrogen use and elevated body mass index (BMI) increase the risk of venous thromboembolism (VTE). Recent data suggest that transdermal estrogen might be safe with respect to thrombotic risk. However, the impact of transdermal estrogen on the association between overweight (25 kg m −2 < BMI ≤ 30 kg m −2 ) or obesity (BMI >30 kg m −2 ) and VTE risk has not been investigated. Methods: We carried a multicenter case–control study of VTE among postmenopausal women aged 45–70 years, between 1999 and 2005, in France. Case population consisted of women with a first documented idiopathic VTE. We recruited 191 hospital cases matched with 416 hospital controls and 62 outpatient cases matched with 181 community controls. Results: The odds ratio (OR) for VTE was 2.5 [95% confidence interval (CI):1.7–3.7] for overweight and 3.9 (95% CI: 2.2–6.9) for obesity. Oral, not transdermal, estrogen was associated with an increased VTE risk (OR = 4.5; 95% CI: 2.6–7.7 and OR = 1.1; 95% CI: 0.7–1.7, respectively). Compared with non‐users with normal weight, the combination of oral estrogen use and overweight or obesity further enhanced VTE risk (OR = 10.2; 95% CI: 3.5–30.2 and OR = 20.6; 95% CI: 4.8–88.1, respectively). However, transdermal users with increased BMI had similar risk as non‐users with increased BMI (OR = 2.9; 95% CI: 1.5–5.8 and OR = 2.7; 95% CI: 1.7–4.5 respectively for overweight; OR = 5.4; 95% CI: 2.1–14.1 and OR = 4.0; 95% CI: 2.1–7.8 respectively for obesity). Conclusions: In contrast to oral estrogen, transdermal estrogen does not confer an additional risk of idiopathic VTE in women with increased BMI. The safety of transdermal estrogen on thrombotic risk has to be confirmed.