{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T15:37:21Z","timestamp":1769355441181,"version":"3.49.0"},"reference-count":84,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"23","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p xml:lang=\"en\">Venous thromboembolism (VTE) is an important vascular disease and public health problem. Prevention of VTE has focused mainly on using thromboprophylaxis to avoid provoked VTE or recurrent VTE, with little attention paid to the possibility of preventing the one third to one half of VTEs that are unprovoked. We review growing research suggesting that unhealthy lifestyle risk factors may cause a considerable proportion of unprovoked VTE. Using epidemiologic data to calculate population attributable risks, we estimate that in the United States obesity may contribute to 30% of VTEs, physical inactivity to 4%, current smoking to 3%, and Western dietary pattern to 11%. We also review possibilities for VTE primary prevention either through a high\u2010risk individual approach or a population\u2010wide approach. Interventions for outpatients at high VTE risk but without VTE provoking factors have not been fully tested; yet, improving patient awareness of risk and symptoms, lifestyle counseling, and possibly statins or direct oral anticoagulants may prove useful in primary prevention of unprovoked VTE. A population approach to prevention would bolster awareness of VTE and aim to shift lifestyle risk factors downward in the whole population using education, environmental changes, and policy. Assuming the epidemiological associations are accurate, causal, and independent of each other, a reduction of obesity, physical inactivity, current smoking, and Western diet by 25% in the general population might reduce the incidence of unprovoked VTE by 12%. We urge further research and consideration that primary prevention of unprovoked VTE may be a worthwhile public health aim.<\/jats:p>","DOI":"10.1161\/jaha.120.019395","type":"journal-article","created":{"date-parts":[[2020,11,16]],"date-time":"2020-11-16T10:02:10Z","timestamp":1605520930000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Exploring Opportunities for Primary Prevention of Unprovoked Venous Thromboembolism: Ready for Prime Time?"],"prefix":"10.1161","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2635-2699","authenticated-orcid":false,"given":"Aaron R.","family":"Folsom","sequence":"first","affiliation":[{"name":"Division of Epidemiology &amp; Community Health School of Public Health University of Minnesota Minneapolis MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7871-6143","authenticated-orcid":false,"given":"Mary","family":"Cushman","sequence":"additional","affiliation":[{"name":"Departments of Medicine and Pathology &amp; Laboratory Medicine Larner College of Medicine at the University of Vermont Burlington VT"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000757"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2015.10.014"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2015.11.033"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/jth.13336"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12959-016-0108-y"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2015.83"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2015.11.026"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2018022954"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000769"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j1065"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.113.000467"},{"key":"e_1_3_1_13_2","first-page":"JOP1900697","article-title":"Successful model for guideline implementation to prevent cancer\u2010associated thrombosis: venous thromboembolism prevention in the ambulatory cancer clinic","volume":"8","author":"Holmes CE","year":"2020","unstructured":"Holmes CE, Ades S, Gilchrist S, Douce D, Libby K, Rogala B, Parenteau E, Cushman M, Holm AK. Successful model for guideline implementation to prevent cancer\u2010associated thrombosis: venous thromboembolism prevention in the ambulatory cancer clinic. JCO Oncol Pract. 2020;8:JOP1900697.","journal-title":"JCO Oncol Pract"},{"key":"e_1_3_1_14_2","volume-title":"The Surgeon General's Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism","author":"Office of the Surgeon General (US), National Heart, Lung, and Blood Institute (US)","year":"2008","unstructured":"Office of the Surgeon General (US), National Heart, Lung, and Blood Institute (US) . The Surgeon General's Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism. Rockville, MD: Office of the Surgeon General (US); 2008."},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2018.4537"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2016.06.012"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.024507"},{"key":"e_1_3_1_18_2","unstructured":"Hales CM Carroll MD Fryar CD Ogden CL. Prevalence of obesity and severe obesity among adults: United States 2017\u20132018. NCHS Data Brief no 360. Hyattsville MD: National Center for Health Statistics; 2020. https:\/\/www.cdc.gov\/nchs\/products\/databriefs\/db360.htm. Accessed October 9 2020."},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-019-00579-2"},{"key":"e_1_3_1_20_2","unstructured":"Anonymous . Current cigarette smoking among adults in the United States. Centers for Disease Control and Prevention. National Center for Health Statistics; 2020. https:\/\/www.cdc.gov\/tobacco\/data_statistics\/fact_sheets\/adult_data\/cig_smoking\/index.htm. Accessed October 9 2020."},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.641688"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1111\/joim.12299"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00439-017-1811-x"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0168878"},{"key":"e_1_3_1_25_2","first-page":"32948842","article-title":"Weight change over 9 years and subsequent risk of venous thromboembolism in the ARIC cohort","author":"French SA","year":"2020","unstructured":"French SA, Lutsey PL, Rosamond W, MacLehose RF, Cushman M, Folsom AR. Weight change over 9 years and subsequent risk of venous thromboembolism in the ARIC cohort. Int J Obes (Lond). 2020. 32948842. https:\/\/doi.org\/10.1038\/s41366\u2010020\u201000674\u20105.","journal-title":"Int J Obes (Lond)"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1673636"},{"key":"e_1_3_1_27_2","unstructured":"Anonymous . Trends in meeting the 2008 physical activity guidelines 2008\u20132018. Centers for Disease Control and Prevention. National Center for Health Statistics; 2020. https:\/\/www.cdc.gov\/physicalactivity\/data\/index.html. Accessed October 7 2020."},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.160.6.809"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1111\/jth.12480"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-151-3-200908040-00129"},{"key":"e_1_3_1_31_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11239-018-1620-7"},{"key":"e_1_3_1_32_2","doi-asserted-by":"publisher","DOI":"10.1258\/shorts.2011.011121"},{"key":"e_1_3_1_33_2","doi-asserted-by":"publisher","DOI":"10.1111\/jth.12860"},{"key":"e_1_3_1_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2009.04.003"},{"key":"e_1_3_1_35_2","doi-asserted-by":"publisher","DOI":"10.1097\/MBC.0b013e3283403537"},{"key":"e_1_3_1_36_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2011.04353.x"},{"key":"e_1_3_1_37_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwr377"},{"key":"e_1_3_1_38_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0045458"},{"key":"e_1_3_1_39_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2011.04588.x"},{"key":"e_1_3_1_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2013.12.018"},{"key":"e_1_3_1_41_2","doi-asserted-by":"publisher","DOI":"10.3945\/jn.113.189548"},{"key":"e_1_3_1_42_2","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-18-0040"},{"key":"e_1_3_1_43_2","doi-asserted-by":"publisher","DOI":"10.1002\/rth2.12168"},{"key":"e_1_3_1_44_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199704173361601"},{"key":"e_1_3_1_45_2","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2020.00032"},{"key":"e_1_3_1_46_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.716407"},{"key":"e_1_3_1_47_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001515"},{"key":"e_1_3_1_48_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41588-019-0519-3"},{"key":"e_1_3_1_49_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0039-1687911"},{"key":"e_1_3_1_50_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.192703"},{"key":"e_1_3_1_51_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.114.001494"},{"key":"e_1_3_1_52_2","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.23950"},{"key":"e_1_3_1_53_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.003954"},{"key":"e_1_3_1_54_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0049-3848(09)70136-7"},{"key":"e_1_3_1_55_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2019.03.021"},{"key":"e_1_3_1_56_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1047-2797(97)00051-3"},{"key":"e_1_3_1_57_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.119.005600"},{"key":"e_1_3_1_58_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000251"},{"key":"e_1_3_1_59_2","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/14.1.32"},{"key":"e_1_3_1_60_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2008.589"},{"key":"e_1_3_1_61_2","doi-asserted-by":"publisher","DOI":"10.1111\/jth.12499"},{"key":"e_1_3_1_62_2","doi-asserted-by":"publisher","DOI":"10.1160\/TH15-04-0306"},{"key":"e_1_3_1_63_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2011-12-397752"},{"key":"e_1_3_1_64_2","doi-asserted-by":"publisher","DOI":"10.1111\/jth.13193"},{"key":"e_1_3_1_65_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000437741.48606.98"},{"key":"e_1_3_1_66_2","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.120.314668"},{"key":"e_1_3_1_67_2","doi-asserted-by":"publisher","DOI":"10.1111\/jth.13031"},{"key":"e_1_3_1_68_2","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2019000975"},{"key":"e_1_3_1_69_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa035029"},{"key":"e_1_3_1_70_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1709118"},{"key":"e_1_3_1_71_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-147-8-200710160-00004"},{"key":"e_1_3_1_72_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3026(16)30184-3"},{"key":"e_1_3_1_73_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0900241"},{"key":"e_1_3_1_74_2","doi-asserted-by":"publisher","DOI":"10.1080\/17474086.2016.1245137"},{"key":"e_1_3_1_75_2","doi-asserted-by":"publisher","DOI":"10.1111\/eci.13130"},{"key":"e_1_3_1_76_2","doi-asserted-by":"publisher","DOI":"10.1111\/jth.14364"},{"key":"e_1_3_1_77_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2018.02.024"},{"key":"e_1_3_1_78_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.10.033"},{"key":"e_1_3_1_79_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.046397"},{"key":"e_1_3_1_80_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.046524"},{"key":"e_1_3_1_81_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1707914"},{"key":"e_1_3_1_82_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1809798"},{"key":"e_1_3_1_83_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1912388"},{"key":"e_1_3_1_84_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e318260a20b"},{"key":"e_1_3_1_85_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000678"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.120.019395","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T11:05:48Z","timestamp":1715598348000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.120.019395"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12]]},"references-count":84,"journal-issue":{"issue":"23","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["10.1161\/JAHA.120.019395"],"URL":"https:\/\/doi.org\/10.1161\/jaha.120.019395","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12]]},"assertion":[{"value":"2020-11-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e019395"}}