Background: Patients with diabetes mellitus (DM) have a hypercoagulable state that may increase their risk for thromboembolism. However, the data about this association are contradictory in the literature. The goal of this study was to evaluate the occurrence of pulmonary embolism (PE) and pulmonary hypertension (PHT) in patients with DM after adjusting for coronary artery disease (CAD), congestive heart failure (CHF), hypertension, and smoking using a large database.
Method: We used patient treatment file documents to inpatient hospital admissions containing discharge diagnoses (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes) from Veterans Health Administration Hospitals. The patients were classified into two groups: a DM group with an ICD-9-CM code for DM (293,124), and a control group with an ICD-9-CM code for hypertension but no DM (552,623). The ICD-9-CM code for PE (415.19) and the ICD-9-CM code for PHT (416.0) were used to study prevalence of these diseases in DM patients vs control patients. We performed univariate and multivariate analyses adjusting for CAD, CHF, and smoking. Continuous variables were analyzed by unpaired t test. Binary variables were analyzed by χ2 and Fisher exact tests.
Results: PE was present in 2,011 patients with DM (0.7%) vs 2,759 patients (0.5%) in the control group. PHT was present in 3,356 patients with DM (1.1%) vs 3,357 patients (0.6%) in the control group. Using multivariate analysis, DM remained independently associated with PE (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.19 to 1.35; p < 0.001) and with PHT (OR, 1.53; 95% CI, 1.45 to 1.60; p < 0.001).
Conclusion: Patients with DM have significantly higher prevalence of PE and PHT independent of CAD, hypertension, CHF, or smoking. The pathogenesis of this association is not known at this time.