Chronic venous diseases and obesity: pathogenetically based treatment and prevention options

Abstract

This literature review analyzes relationships and correlations between obesity and chronic venous diseases. The search of scien tific publications was carried out in the Cochrane Library, PubMed, Medscape and Medline databases in accordance with the PRISMA guidelines. The review includes only publications, which were particularly relevant to our focus of research and where a significance difference between “experience and control” groups was found based on the results of statistical analysis. All studies included in the analysis defined obesity as a body mass index of 30.0 kg/m2 or more, and overweight as a BMI from 25 to 30 kg/m2 according to the criteria of the World Health Organization. The findings of publication analysis show that excess body weight, and especially obesity, is a major independent risk factor for the development and progression of chronic venous diseases and their complications. In addition, a direct cause-and-effect relationship between body weight and the severity of chronic venous insufficiency was observed. Increased intra-abdominal pressure associated with the visceral fat deposition is one of the key features of the pathogenesis of chronic venous diseases in patients with overweight and obesity. In this context, bariatric surgery, after which weight loss correlates with falling into a lower clinical class of chronic venous diseases is the most effective method for improving phlebological status. Along with bariatric surgery, the pharmacotherapeutic options are considered in patients with chronic venous diseases with underlying overweight and burdened comorbidities anamnesis. In this regard, the role of hesperidin combined and diosmin that have been shown to be most effective phlebotropic drug is discussed. Recent studies demonstrate that hesperidin has independent pluripotent properties, among which the mechanisms of action of this substance on lipid metabolism accompanied by a decrease in subjects’ body weight and visceral fat volume are a matter of interest. After completion of full-fledged clinical studies this action of hesperidin can be implemented in various treatment-and-prophylactic protocols on the management of patients with chronic venous diseases, related to underlying overweight and morbid obesity. Venarus® contains two micronized components hesperidin and diosmin at standardized dosages: 10% hesperidin and 90% diosmin, which can be used as an argument in favour of choosing this drug to treat patients with chronic venous diseases, related to underlying obesity or overweight.