Epidemiology of chronic venous disease

Abstract

Chronic venous disease of the legs occurs commonly in the general population in the Western world. Estimates of the prevalence of varicose veins vary widely from 2-56% in men and from 1-60% in women. These variations reflect differences in variability of study populations including age, race and gender, methods of measurement and disease definition. Definitions of chronic venous disease may rely on reports of varicose veins by study participants, based on self-diagnosis or recall of a diagnosis, or on a standardized physical examination. Venous ulceration is less common, affecting approximately 0.3% of the adult population. Age and pregnancy have been established as risk factors for developing varicose veins. Evidence on other risk factors for venous disease is inconclusive. Prolonged standing has been proposed, but results of studies should be interpreted with caution given the difficulty in measuring levels of posture. Obesity has been suggested as a risk factor in women, but appears to be an aggravating factor rather than a primary cause. Other postulated risk factors include dietary intake and smoking, but evidence is lacking. Longitudinal studies using standardized methods of evaluation are required before the true incidence of chronic venous disease and associated risk factors can be determined.

The relationship between increased body mass index and primary venous disease severity and concomitant deep primary venous reflux

“…In the present study as in other publications with the same finding, there could be a selection bias because women may be more aware of their varicose veins than men and will more easily consult and undergo surgical treatment and may therefore be more readily selected for these studies. As Robertson et al 23 pointed out in their epidemiological research, the variation in the prevalence of varicose veins in men and women in the studies examined by the authors, reflect differences in variability of study population including age, race, and gender, methods of measurement, and disease definition. The fact that the results had not been adjusted for age may especially contribute to the observed gender differences.…”

Is vein damage the only cause of clinical signs of lower limb chronic venous insufficiency?

“…14,26 It does not appear likely that obesity could be a risk factor for one sex but not for the other, and it can be considered as an aggravating factor in venous disease. 18,25,27 In this study, obese women were more likely to have trunk lesions as etiology of their symptoms. Hypotonic phlebopathy, defined as CVI published data showing that women suffer from vascular diseases with greater frequency than men and are more symptomatic.…”

“…There are studies that claim that there is only a relationship between obesity and CVI, 3,6,24 or an association between varicose veins and BMI, among women, 1,5,14,25 and others that found no evidence of any relationship. 14,26 It does not appear likely that obesity could be a risk factor for one sex but not for the other, and it can be considered as an aggravating factor in venous disease.…”

“…This result contrasts with data reported by Andreozzi et al, 9 since they found a relationship between hypotonic phlebopathy and obesity, but it is in line with other results in the literature indicating that the association between BMI and varicose veins is stronger among women. 1,5,14,25 Another factor investigated was distribution by age group of the hypotonic phlebopathy patients. This analysis showed that the highest prevalence (64%) is among younger people aged < 30 years (2:1) and that prevalence reduces as age increases, as symptoms become more likely to be related to anatomic venous injuries.…”

“…Many studies have shown that age is a risk factor for varicose veins and for exacerbation of CVI. 8,14,25 The Acireale project described by Andreozzi et al found that the prevalence of this subset was 15%. The difference can be explained by the fact that the sample described in the present article was made up of symptomatic patients, whereas Andreozzi et al calculated the prevalence in a sample representative of the general population.…”