We have made great strides over the past 2-3 decades in reducing deaths from cardiovascular diseases in the United States and elsewhere. However, a menacing threat to health is not well known to people: venous thrombosis. This consists of blood clots forming abnormally in the leg veins (deep vein thrombosis or DVT) or the lung arteries (pulmonary embolus or PE). Clots can travel from the leg veins to the lung, and when this happens it can be deadly. In the 30 days following a DVT or PE, 1 in 10 people will die. The stakes are even higher in cancer patients, where 1 in 4 will die. Some patients are never even known to have this disease when they die, since PE is a cause of sudden death, and can only then be diagnosed by an autopsy.
Why am I writing about this?
The awareness of this problem is very low, with less than 1 in 4 Americans even knowing about it. At the same time, this is the third leading vascular diagnosis after heart attack and stroke. Statistics are hard to come by because it isn’t tracked as closely as other diseases, but it is thought that up to one million Americans annually are affected by the disease. What does it mean to be affected? As mentioned above, people die of this disease. Apart from that, DVT can cause substantial pain and swelling of the leg. Even after treatment, leg symptoms can become a lifelong issue for patients. When it starts, PE causes chest pain and trouble breathing. Often people think they are having a heart attack. Fortunately, once treatment is given most patients recover, although a few will have long term problems with their breathing.
What can we do about this?
The most important thing is to increase awareness of the disease so it can be prevented, or at least diagnosed early and treated. This can save lives! Many patients that I see experience weeks of symptoms before they present for care. This can lead to worse outcomes or death. Bottom line: if you have symptoms you need to seek medical care.
The next thing to do is to understand about prevention of clots. About half of these clots occur after surgery, trauma or immobilization, or in cancer patients. Among women, using birth control or menopausal estrogen treatment, and pregnancy are risk factors. If you fit into any of these groups you should ask your care provider how to prevent clots. People with a family history of DVT or PE are also at higher risk than others. This is especially true if the disease affected a close relative (sibling, parent or child) and if it occurred at a young age in the relative. Apart from this, getting older and obesity are the major risk factors for DVT and PE. Our country has become increasingly obese. We are working hard in Vermont to curb obesity through government advocacy efforts in childhood obesity and reducing sugary beverages. But for individuals, the issue is thinking about the calories you eat and how much you move. It’s simple; if you don’t burn more calories in physical activity than you eat, you will gain weight. Everyone needs to educate themselves about this.
Mary Cushman, MD, MSc, is a hematologist at the University of Vermont Medical Center where she is Medical Director for the Thrombosis and Hemostasis Program. She is Professor of Medicine at the Larner College of Medicine at UVM. She currently serves on the Vermont board of directors for the American Heart Association and board member of the Cardiovascular Research Institute of Vermont.