Contrasting Associations of Prudent and Western Dietary Patterns with Risk of Developing Venous Thromboembolism

Published:February 16, 2021DOI:



      Published studies are inconsistent about whether differences in diet are associated with risk of venous thromboembolism. We studied the association between dietary patterns and incident venous thromboembolism in a large US cohort.


      The Atherosclerosis Risk in Communities study followed 14,818 middle-aged males and females for incident venous thromboembolism over an average of 22 years between 1987 and 2015. Trained interviewers assessed dietary intake at visits 1 and 3, using a food frequency questionnaire. We derived 2 dietary pattern scores using principal component analysis and ascertained and verified hospitalized venous thromboembolism. In separate proportional hazards regression analyses, we examined associations of quintiles of the prudent and the Western dietary pattern scores with risk of developing non-cancer-related and total venous thromboembolism, adjusting for demographic characteristics, lifestyle factors, body mass index, and diabetes.


      With 860 total incident venous thromboembolism events, the hazard ratios (95% confidence intervals) of incident non-cancer-related venous thromboembolism (n = 631) across quintiles of the prudent dietary pattern score were 1 (reference), 1.04 (0.81-1.32), 0.84 (0.65-1.08), 0.70 (0.53-0.91), and 0.88 (0.67-1.15), Ptrend = .04. Across quintiles of the Western dietary pattern score, hazard ratios of non-cancer-related venous thromboembolism were 1 (reference), 1.13 (0.87-1.45), 1.20 (0.92-1.56), 1.03 (0.77-1.39), and 1.58 (1.13-2.21), Ptrend = .04. Associations were similar for total venous thromboembolism.


      In this community-based cohort, a prudent dietary pattern was associated with a lower risk of future venous thromboembolism, whereas a Western dietary pattern was associated with a higher risk.


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        • Folsom AR
        • Cushman M
        Exploring opportunities for primary prevention of unprovoked venous thromboembolism: Ready for prime time?.
        J Am Heart Assoc. 2020; 9e019395
        • Steffen LM
        • Folsom AR
        • Cushman M
        • Jacobs DR Jr
        • Rosamond WD
        Greater fish, fruit, and vegetable intakes are related to lower incidence of venous thromboembolism: the Longitudinal Investigation of Thromboembolism Etiology.
        Circulation. 2007; 115: 188-195
        • Fitzgerald KC
        • Chiuve SE
        • Buring JE
        • Ridker PM
        • Glynn RJ
        Comparison of associations of adherence to a Dietary Approaches to Stop Hypertension (DASH)-style diet with risks of cardiovascular disease and venous thromboembolism.
        J Thromb Haemost. 2012; 10: 189-198
        • Bhoopat L
        • Rojnuckarin P
        • Hiransuthikul N
        • Intragumtornchai T
        Low vegetable intake is strongly associated with venous thromboembolism in Thai population.
        Blood Coagul Fibrinolysis. 2010; 21: 758-763
        • Severinsen MT
        • Overvad K
        • Andersen VL
        • Tjønneland A
        • Schmidt EB
        • Kristensen SR
        Fish intake and venous thromboembolism: a Danish follow-up study.
        Thromb Res. 2014; 133: 352-356
        • Hansen-Krone IJ
        • Enga KF
        • Südduth-Klinger JM
        • et al.
        High fish plus fish oil intake is associated with slightly reduced risk of venous thromboembolism: the Tromsø Study.
        J Nutr. 2014; 144: 861-867
        • Lutsey PL
        • Steffen LM
        • Virnig BA
        • Folsom AR
        Diet and incident venous thromboembolism: the Iowa Women's Health Study.
        Am Heart J. . 2009; 157: 1081-1087
        • Enga KF
        • Braekkan SK
        • Hansen-Krone IJ
        • Wilsgaard T
        • Hansen JB
        Coffee consumption and the risk of venous thromboembolism: the Tromsø study.
        J Thromb Haemost. 2011; 9: 1334-1339
        • Varraso R
        • Kabrhel C
        • Goldhaber SZ
        • Rimm EB
        • Camargo CA Jr
        Prospective study of diet and venous thromboembolism in US women and men.
        Am J Epidemiol. 2012; 175: 114-126
        • Hansen-Krone IJ
        • Enga KF
        • Njølstad I
        • Hansen JB
        • Braekkan SK
        Heart healthy diet and risk of myocardial infarction and venous thromboembolism. The Tromsø Study.
        Thromb Haemost. 2012; 108: 554-560
        • Appel LJ
        • Moore TJ
        • Obarzanek E
        • et al.
        A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group.
        N Engl J. 1997; 336: 1117-1124
        • Willett WC
        • Sampson L
        • Stampfer MJ
        • et al.
        Reproducibility and validity of a semiquantitative food frequency questionnaire.
        Am J Epidemiol. 1985; 122: 51-65
        • Fung TT
        • Rimm EB
        • Spiegelman D
        • et al.
        Association between dietary patterns and plasma biomarkers of obesity and cardiovascular disease risk.
        Am J Clin Nutr. 2001; 73: 61-67
        • Hu FB
        Dietary pattern analysis: a new direction in nutritional epidemiology.
        Curr Opin Lipidol. 2002; 13: 3-9
        • Weng LC
        • Steffen LM
        • Szklo M
        • Nettleton J
        • Chambless L
        • Folsom AR
        A diet pattern with more dairy and nuts, but less meat is related to lower risk of developing hypertension in middle-aged adults: the Atherosclerosis Risk In Communities (ARIC) study.
        Nutrients. 2013; 5: 1719-1733
        • Cushman M
        • Tsai AW
        • White RH
        • et al.
        Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology.
        Am J Med. 2004; 117: 19-25
        • Richardson MT
        • Ainsworth BE
        • Wu HC
        • Jacobs DR Jr
        • Leon AS
        Ability of the Atherosclerosis Risk in Communities (ARIC)/Baecke Questionnaire to assess leisure-time physical activity.
        Int J Epidemiol. 1995; 24: 685-693
        • Hoevenaar-Blom MP
        • Nooyens AC
        • Kromhout D
        • et al.
        Mediterranean style diet and 12-year incidence of cardiovascular diseases: the EPIC-NL cohort study.
        PLoS One. 2012; 7: e45458
        • Ohira T
        • Iso H
        • Yamagishi K
        • Tamakoshi A, JACC Study Group
        Fish intake and death from pulmonary embolisms among Japanese men and women - The Japan Collaborative Cohort (JACC) Study.
        Circ J. 2018; 82: 2063-2070
        • Rehm CD
        • Peñalvo JL
        • Afshin A
        • Mozaffarian D
        Dietary intake among US adults, 1999-2012.
        JAMA. 2016; 315: 2542-2553
      1. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at Accessed September 20, 2020.

        • Isaksen T
        • Evensen LH
        • Johnsen SH
        • et al
        Dietary intake of marine n-3 polyunsaturated fatty acids and future risk of venous thromboembolism.
        Res Pract Thromb Haemost. 2018; 3: 59-69