Abstract 4143788: Physical Activity Reduces Incident DVT Risk: Greater Impact Among Individuals with Anxiety or Depression

Background: Physical activity (PA) reduces cardiovascular (CV) disease risk, and this has recently been shown to be due, in part, to reduction of stress-related neural activity (SNA). Further, the CV benefits of PA are higher in individuals likely to have higher baseline SNA (i.e., those with depression/anxiety). Moreover, anxiety and depression associate with increased risk of deep venous thrombosis (DVT) partly through increased SNA, yet it remains unknown how PA impacts this relationship. Hypotheses: 1) PA associates with lower risk of DVT, 2) this PA benefit is more pronounced in individuals with anxiety and depression. Aims: To evaluate the association between PA and DVT risk and the differential benefits among subjects with anxiety or depression. Methods: Subjects enrolled in the Mass General Brigham Biobank were studied; total PA was derived from a health survey that assessed different activities during the previous year. Higher vs lower PA was defined according to quintiles of PA in our population (low PA: 1° and 2° quintile; high PA: 4° and 5° quintile; subjects in the 3° quintile were excluded to avoid possible overlaps). Depression, anxiety, and DVT were defined using ICD codes. Subjects <18 years old or with previous DVT were excluded. Risk of incident DVT was investigated with multivariable Cox-regression. Results: 49,081 subjects (mean age 53.8 ± 16.6 yrs, 39.8% male) were studied. The incidence of DVT progressively decreased across quintiles of PA (2.1% vs 1.9% vs 1.7% vs 1.3% vs 1.2%; p<0.001). High PA was associated with lower risk of incident DVT after adjustment for the most common DVT risk factors (age, sex, cancer, oral contraceptives, and obesity; HR 0.764 [95% CI 0.648-0.901, p=0.001]) and additional confounders ( Fig. 1A ). The beneficial effect of PA on DVT risk was higher in those with anxiety and depression (interaction with anxiety p=0.002; interaction with depression p=0.052; Fig. 1B ). Conclusion: PA associates with lower risk of DVT, and this association is more pronounced among individuals with anxiety or depression. These results provide further support for a brain-clot connection and suggest that further mechanistic studies are needed.