Visible varicose veins

Association of Varicose Veins With Incident Venous Thromboembolism and Peripheral Artery Disease

Shyue-Luen Chang ^1 2 3, Yau-Li Huang ^1 2 3, Mei-Ching Lee ^1 2 3, Sindy Hu ^1 2 3 4, Yen-Chang Hsiao ⁵, Su-Wei Chang ^6 7, Chee Jen Chang ^8 9, Pei-Chun Chen ^6 10

PMID: 29486040 PMCID: PMC5838574 DOI: 10.1001/jama.2018.0246

Free PMC article

Abstract

Importance: Varicose veins are common but rarely associated with serious health risks. Deep venous thrombosis (DVT), pulmonary embolism (PE), and peripheral artery disease (PAD) are also vascular diseases but associated with serious systemic effects. Little is known about the association between varicose veins and the incidence of other vascular diseases including DVT, PE, and PAD.

Objective: To investigate whether varicose veins are associated with an increased risk of DVT, PE, or PAD.

Design, setting, and participants: A retrospective cohort study using claims data from Taiwan’s National Health Insurance program. Patients aged 20 years and older with varicose veins were enrolled from January 1, 2001-December 31, 2013, and a control group of patients without varicose veins were matched by propensity score. Patients previously diagnosed with DVT, PE, or PAD were excluded. Follow-up ended December 31, 2014.

Exposures: Presence of varicose veins.

Main outcomes and measures: Incidence rates of DVT, PE, and PAD were assessed in people with and without varicose veins. Cox proportional hazards models were used to estimate relative hazards, with the control group as reference.

Results: There were 212 984 patients in the varicose veins group (mean [SD] age, 54.5 [16.0] years; 69.3% women) and 212 984 in the control group (mean [SD] age, 54.3 [15.6] years; 70.3% women). The median follow-up duration was 7.5 years for DVT, 7.8 years for PE, and 7.3 years for PAD for patients with varicose veins, and for the control group, follow-up duration was 7.6 years for DVT, 7.7 years for PE, and 7.4 years for PAD. The varicose veins group had higher incidence rates than the control group for DVT (6.55 vs 1.23 per 1000 person-years [10 360 vs 1980 cases]; absolute risk difference [ARD], 5.32 [95% CI, 5.18-5.46]), for PE (0.48 for the varicose veins group vs 0.28 for the control group per 1000 person-years [793 vs 451 cases]; ARD, 0.20 [95% CI, 0.16-0.24]), and for PAD (10.73 for the varicose veins group vs 6.22 for the control group per 1000 person-years [16 615 vs 9709 cases]; ARD, 4.51 [95% CI, 4.31-4.71]). The hazard ratios for the varicose veins group compared with the control group were 5.30 (95% CI, 5.05-5.56) for DVT, 1.73 (95% CI, 1.54-1.94) for PE, and 1.72 (95% CI, 1.68-1.77) for PAD.

Conclusions and relevance: Among adults diagnosed with varicose veins, there was a significantly increased risk of incident DVT; the findings for PE and PAD are less clear due to the potential for confounding. Whether the association between varicose veins and DVT is causal or represents a common set of risk factors requires further research.

Reference

JAMA. 2018 Feb 27;319(8):807-817. doi: 10.1001/jama.2018.0246.

Presence of varicose veins in cancer patients increases the risk for occurrence of venous thromboembolism

O Königsbrügge ¹, F Lötsch, E-M Reitter, T Brodowicz, C Zielinski, I Pabinger, C Ay

Affiliations expand

PMID: 24112869.  DOI: 10.1111/jth.12408

Free article

Abstract

Background: Cancer patients are at increased risk of venous thromboembolism (VTE).

Objective: We investigated the association of a history of VTE, superficial thrombophlebitis, or the presence of varicose veins with the occurrence of VTE during the course of cancer.

Methods: Cancer patients were recruited in a prospective cohort study, the Vienna Cancer and Thrombosis Study. Patients who had VTE within 3 months before study inclusion were excluded. At study inclusion, history of VTE, history of superficial thrombophlebitis, and presence of varicose veins were recorded. Primary end point was the occurrence of symptomatic VTE. Hazard ratios were obtained using the competing risk analysis according to Fine and Gray.

Results: The cohort consisted of 1270 patients followed over a median of 590 days. A history of VTE was found in 66 patients (5.2%), superficial thrombophlebitis in 79 patients (6.2%), and varicose veins in 160 patients (12.6%). Ninety-eight patients (7.7%) developed VTE during follow-up. The hazard ratios for the risk of VTE in patients with a history of VTE or superficial thrombophlebitis were 1.44 (95% confidence interval: 0.67-3.07) and 1.94 (1.04-3.61), respectively, and 2.01 (1.26-3.21) in those with varicose veins. In multivariable analysis including history of VTE, history of superficial thrombophlebitis, presence of varicose veins, and other patient-related factors, the presence of varicose veins (2.10 [1.29-3.41]) remained significantly associated with an increased risk of VTE.

Conclusion: The presence of varicose veins is associated with an elevated risk of VTE in cancer patients. This clinical parameter could be useful for individual risk assessment of VTE in these patients.

Reference:

J Thromb Haemost. 2013 Nov;11(11):1993-2000. doi: 10.1111/jth.12408.

Varicose veins are a risk factor for deep venous thrombosis in general practice patients

Uwe Müller-Bühl ¹, Rüdiger Leutgeb, Peter Engeser, Edwane N Achankeng, Joachim Szecsenyi, Gunter Laux

Affiliations expand

PMID: 22915533. DOI: 10.1024/0301-1526/a000222

Abstract

Background: The role of varicose veins (VV) as a risk factor for development of deep venous thrombosis (DVT) is still controversial. The aim of this study in primary care was to determine the impact of varicosity as a potential risk factor for developing DVT.

Patients and methods: During the observation period between 01-Jan-2008 and 01-Jan-2011, all cases with VV (ICD code I83.9) and DVT (ICD codes I80.1 – I80.9) were identified out of the CONTENT primary care register (Heidelberg, Germany). The exposure of VV and DVT was based solely on ICD coding without regarding the accuracy of the diagnosis. The covariates age, gender, surgery, hospitalization, congestive heart failure, malignancy, pregnancy, hormonal therapy, and respiratory infection were extracted for each patient. Multivariate binary logistic regression was performed in order to assess potential risk factors for DVT. The SAS procedure “PROC GENMOD” (SAS version 9.2, 64-bit) was parameterised accordingly. A potential cluster effect (patients within practices) was regarded in the regression model.

Results: There were 132 out of 2,357 (5.6 %) DVT episodes among patients with VV compared to 728 out of 80,588 (0.9 %) in the patient cohort without VV (p < 0.0001). An increased risk of DVT was associated with previous DVT (adjusted odds ratio (OR): 9.07, 95 % confidence interval (CI): 7.78 – 10.91), VV (OR 7.33 [CI 6.14 – 8.74]), hospitalization during the last 6 months (OR 1.69 [CI 1.29 – 2.22]), malignancy (OR 1.55 [CI 1.19 – 2.02]), and age (OR 1.02 [CI 1.01 – 1.03]).

Conclusions: There are strong associations between VV and DVT in a general practice population with documented VV. Special medical attention is required for patients with VV, a history of previous venous thromboembolism, comorbid malignancy, and recent hospital discharge, particularly those with a combination of these factors.

Reference:

Vasa. 2012 Sep;41(5):360-5. doi: 10.1024/0301-1526/a000222.