Deep Vein Thrombosis
Obesity and Deep Vein Thrombosis: Leading Cause of Death by Pulmonary Embolism
While there are undoubtedly many hereditary conditions (1)(2) that contribute to the risk of developing deep vein thrombosis, or deep venous thrombosis (DVT), it has been noted by leading scientific news sites (3) and researchers (4) that there is a very strong link between obesity, pulmonary embolism and deep vein thrombosis. Obesity is determined by calculating your body mass index (BMI) and if this number is in the vicinity of 30 or higher, then it can be said that you are dangerously obese. Pulmonary embolism (5) is a blockage of the main artery leading to the lung or one of its side branches by any substance that has traveled from elsewhere in the body through the bloodstream. Most times, this is due to a blood clot (thrombus) that has formed in deep veins in the legs. The link between obesity and deep vein thrombosis has also been established, (6) as one of the substances that can form blood clots in the veins is body-fat. For example, cancer patients have been known to die of pulmonary embolism caused by deep vein thrombosis due to sudden weight-loss in combination with blood clotting while they were bed-ridden without the use of a prophylactic anticoagulant. (7)
Women under 40 at greatest risk
In an extensive study published in The American Journal of Medicine, (8) St. Joseph Mercy Oakland Hospital, Wayne State University and Oakland University researchers were able to analyze more than 20 years of patient records compiled by the National Hospital Discharge Survey (NHDS). (9) The investigators concluded resoundingly that obesity is most certainly a risk factor for deep vein thrombosis disease in men and women, particularly in those aged under 40. (10) The comprehensive data, which covered obese patients from many different racial and age backgrounds from an annual sample of 181,000 to 307,000 patients, is significant enough to be definitive in its conclusions. (11) Obese people are in immediate and present danger from death by deep vein thrombosis and pulmonary embolism and should take action at once to restore their body mass index to a level ideal for their body-height.
A lack of exercise can exacerbate the condition
A lack of physical activity in a person’s regular routine can contribute to the development of deep vein thrombosis. (12) Because obesity is also a major factor that results in people not doing as much physical activity as they should be, the conditions are deeply intertwined. Obese people generally find it difficult to move about, (13) their mobility is limited, they may have trouble using the bathroom and will need to have special fixtures installed to use the toilet or the shower. In many cases, they will not be able to do everyday things comfortably, such as tying shoelaces, bending down, even moving about the house will cause them to break out into a sweat and going to the store or using stairs can be quite a trying ordeal for them. Obese people may be short of breath and develop all sorts of issues that are symptoms of deep vein thrombosis, such as discoloration of the skin, leg pain, leg sores, swelling in the legs and long term vein damage. (14) |f a blood clot develops above the knee, then it has a high chance of breaking off and being pushed along the bloodstream. This is where it can become lodged in a blood vessel leading to the lung and cause a pulmonary embolism.
Both men and women have a chance of developing deep vein thrombosis, but the risk is greater in women under the age of 40. (15) What’s worse, is that women who are obese and under the age of 40 are six times more likely to develop deep vein thrombosis than regular-sized women. (16) The risk of deep vein thrombosis in obese men is only three times higher than for their non-obese counterparts.
Symptoms of deep vein thrombosis
The symptoms of deep vein thrombosis are indicative of a deep vein becoming clotted in the leg, although it’s quite possible that it can develop in the arm or other deep veins all over the patient’s body. The most common symptoms are general calf pain, calf pain that increases when the patient is using bipedal functions such as standing or walking and even unusual swelling in the calf. Various factors need to be taken into account to diagnose deep vein thrombosis, the major ones are the family history, a Doppler ultrasound and a venography, which is a type of X-ray taken after a dye is injected into a vein to evaluate the blood flow and look for any potential obstructions.
Treatment
The most common ways to treat deep vein thrombosis are by using an anticoagulant or blood thinner. (18) However, long-term treatment usually involves a rigorous routine that includes exercise and work-outs with a view to get a fit and healthy body back to the body mass index appropriate to the patient.
Long term methods of combat
There are many ways to combat deep vein thrombosis in the long term as it relates to obesity. (19) The most important is to attempt to lower your body mass index to 30 or below if you are obese; ideally you should be aiming for somewhere in between 18-24, but this is a long-term commitment that requires a lot of dedication. One of the biggest inhibitors to an obese person is that the exercise is actually so hard for them. For this reason, other solutions may be presented such as FDA-approved weight loss medication, stomach rings and even liposuction. (20) These methods are usually used to “kick start” the weight-loss process, but care has to be taken and the regimen only applied with strict medical consultation as there are often side-effects associated with weight loss that can be very detrimental to a person who is extremely obese. But weight is always very easy to put back on, in fact, it only takes a few months of an unhealthy lifestyle to end up in the obese category again, so care has to be taken that the patient’s will is strong enough.
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1. Hyperhomocysteinemia as a risk factor for deep-vein thrombosis, Martin den Heijer, MD, Ted Koster, MD, Henk J Blom PHD, Gerard MJ Bos, MD, Ernest Briet, MD, Pieter H Reitsma, PHD, Jan P Vandenbroucke, MD, Frits R Rosendaal, MD, New England Journal of Medicine, March 1996
2. Case-control study of risk of cerebral sinus thrombosis in oral contraceptive users who are carriers of hereditary prothrombotic conditions, S F T M de Bruijn, J Stam, M M W Koopman, J P Vandenbroucke, BMJ 316 : 589, February 1998
3. Obesity Strongly Linked To Pulmonary Embolism And Deep Venous Thrombosis, Science Daily, Sep 9 2005, accessed June 23rd, 2011,
http://www.sciencedaily.com/releases/2005/09/050909075546.htm
4. Obesity as a risk factor in venous thromboembolism, Paul D. Stein, MD, Afzal Beemath, MD, Ronald E. Olson, PhD, The American Journal of Medicine, Volume 118, Number 9, September 2005, accessed online June 23rd, 2011, http://www.amjmed.com/article/S0002-9343(05)00207-X/fulltext
5. Pulmonary embolism, Science Daily, accessed June 23rd, 2011,
http://www.sciencedaily.com/articles/p/pulmonary_embolism.htm
6. “This result suggests that obesity caused by excess body fat is likely to be a risk factor for venous thrombosis.”, Risk of venous thrombosis: obesity and its joint effect with oral contraceptive use and prothrombotic mutations, Elisabeth R. Pomp, Saskia Le Cessie, Frits R. Rosendaal, Carine J. M. Doggen, British Journal of Haematology, Volume 139, Issue 2, pages 289–296, October 2007
7. Fatal Pulmonary Embolism in Cancer Patients: Is Heparin Prophylaxis Justified, SHEN, VINCENT S. MD; POLLAK, ERICH W. MD, Volume 73, Issue 7, 1980, Southern Medical Journal
8. Obesity as a risk factor in venous thromboembolism, Stein et. al., 2005
9. ibid.
10. ibid.
11. ibid.
12. “To prevent obesity: Limit caloric intake, exercise, and avoid saturated fats.”, Pulmonary Embolism and Deep Vein Thrombosis, Samuel Z. Goldhaber, MD; Ruth B. Morrison, RN, BSN, CVN, Correspondence to Samuel Z. Goldhaber, MD, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115.
13. Care and mobility considerations, Department for Work and Pensions, United Kingdom, April 2008, accessed June 23rd, 2011, http://www.dwp.gov.uk/publications/specialist-guides/medical-conditions/a-z-of-medical-conditions/obesity/care-and-mobility/
14. ibid.
15. 8. Obesity as a risk factor in venous thromboembolism, Stein et. al., 2005
16. Diagnosis of Deep-Vein Thrombosis Using Duplex Ultrasound, Richard H. White, MD; John P. McGahan, MD; Martha M. Daschbach; andRoss P. Hartling, MD, August 15, 1989, vol. 111 no. 4 297-304, Annals of Internal Medicine
17. Fatal Pulmonary Embolism in Cancer Patients: Is Heparin Prophylaxis Justified, Shen et al.
18. http://en.wikipedia.org/wiki/Pulmonary_embolism#Treatment
19. ibid.
20. http://en.wikipedia.org/wiki/Obesity#Management