Patients with idiopathic thrombocytopenic purpura (ITP) may be at an increased risk of cardiovascular disease (CVD) compared with the general population, according to a study to be published in the Journal of Thrombosis and Haemostasis.1
Previous studies showed that there may be an association between ITP and CVD — especially among those who undergo splenectomy — but evidence is conflicting.
For this retrospective cohort study, researchers accessed The Health Improvement Network (THIN) and identified 6591 patients with ITP; patients were matched with 24,275 control patients based on age, gender, body mass index, and smoking status. Patients were ineligible if they had a prior history of CVD.
The median follow-up was 5.6 years for the ITP group and 6 years for the control group.
Nearly 400 (5.9%) patients vs 1114 (4.5%) patients in the ITP group vs control group, respectively, had a cardiovascular event during observation (adjusted incidence rate ratio [IRR], 1.38; 95% CI, 1.23-1.55; P < .001).
Patients with ITP had a higher incidence of ischemic heart disease (IRR, 1.21; 95% CI, 1.01-1.44; P = .034), heart failure or left ventricular dysfunction (IRR, 1.42; 95% CI, 1.12-1.81; P = .004), and stroke or transient ischemic attack (IRR, 1.39; 95% CI, 1.17-1.66; P < .001).
Patients with ITP who underwent splenectomy at baseline had a greater rate of CVD compared with those with ITP who did not undergo splenectomy (adjusted IRR, 1.69; 95% CI, 1.22-2.34; P = .001); patients with ITP receiving active steroid therapy at baseline had a higher incidence of CVD compared with patients with ITP who did not receive steroids (adjusted IRR, 1.49; 95% CI, 1.07-2.08; P = .017).
The authors concluded that “physicians should routinely evaluate for cardiovascular symptoms and manage risk factors for cardiovascular disease optimally in patients with ITP. Decision on offering splenectomy to patients with ITP should take into consideration future increased risk of cardiovascular disease.”
- Chandan JS, Thomas T, Lee S, Marshall T, Willis B, Nirantharakumar K. The association between idiopathic thrombocytopenic purpura and cardiovascular disease: a retrospective cohort study. J Thromb Haemost. In press.