Severe varicose veins and the risk of mortality: a nationwide population-based cohort study

Abstract

ObjectiveVaricose veins (VVs) are common and although considered benign may cause morbidity. However, the association between VV severity and cardiovascular and mortality risks remains unknown. The aim of this study was to investigate the factors associated with overall mortality in patients with VV.MethodsA total of 4644 patients with newly diagnosed VV between 1999 and 2013 were identified from Taiwan’s National Health Insurance Database. VV severity was classified from grade 1 to 3 according to the presentation of ulcers or inflammation. Moreover, 9497, 2541 and 5722 age-matched, sex-matched and chronic cardiovascular risk factor-matched controls, as assessed based on propensity score, were separately selected for three grading VV groups. Enrolled patients were analysed using conditional Cox proportional hazards regression analysis to estimate risk of mortality and major adverse cardiovascular events (MACEs) in the VV and control groups.ResultsMost patients with VV were free from systemic disease. However, compared with matched controls, patients with VV showed a 1.37 times increased risk of mortality (95% CI 1.19 to 1.57; p<0.0001). Compared with matched controls, older (age ≧65 years) (adjusted HR: 1.38; 95% CI 1.17 to 1.62; p=0.0001) and male patients with VV (adjusted HR 1.41; 95% CI 1.18 to 1.68; p=0.0001) showed increased risk of mortality. Furthermore, compared with controls, patients with VV showed 2.05 times greater risk of MACE. Compared with matched controls, population at grade 3 increased 1.83 times risk of mortality and 2.04 to 38.42 times risk of heart failure, acute coronary syndrome, ischaemic stroke and venous thromboembolism.ConclusionsThis nationwide cohort study demonstrated that patients with VV are at a risk of cardiovascular events and mortality. Our findings suggest that presence of VV warrants close attention in terms of prognosis and treatment.

Cognitive Function Changes in Older People. Results of Second Wave of Cognition of Older People, Education, Recreational Activities, NutritIon, Comorbidities, fUnctional Capacity Studies (COPERNICUS)

“…Other cross-sectional studies also indicate that peripheral arterial disease and cardiovascular disorders were associated with an increased risk of vascular dementia ( Newman et al, 2005 ; Laurin et al, 2007 ). The presence of varicose veins is related to an increased risk of cardiovascular events and mortality ( Wu et al, 2020 ). Varicose veins might induce inflammation ( Markovic and Shortell, 2013 ) and endothelial dysfunction ( Komarów et al, 2014 ).…”

“…Hormones produced by visceral fat might play a role in cognitive function decline ( Nota et al, 2020 ). Varicose veins presence is a risk factor for cardiovascular events and mortality ( Wu et al, 2020 ). Varicose veins might induce inflammation ( Markovic and Shortell, 2013 ) and endothelial dysfunction ( Komarów et al, 2014 ).…”

Effect of classical surgical treatment under spinal anesthesia on venous thromboembolism in varicose veins patients

“…Virchow's triad, consisting of endothelial damage, hypercoagulability, and stasis, plays a significant role in the etiopathogenesis of venous thromboembolism. Venous stasis is expected in patients with varicose veins, especially in those with dense pacts, which predisposes to thromboembolic events [15].…”

“…Factors involved in the formation of varicose veins cause the remodeling of the vascular wall, the destruction and failure of the venous valves. With the inclusion of leukocytemediated inflammation, it may cause endothelial dysfunction, edema, ulcers and, in advanced stages, deep vein thrombosis [15]. All these events cause an increase in thrombocyte volume, a.k.a.…”

Chronic venous disease. Part 1: pathophysiology and clinical features

“…Similar concerns were echoed in a large population‐based study carried out by Prochaska et al ., who found that the higher CEAP score was associated with a higher ‘predicted 10‐year risk for incident cardiovascular disease’ 37 . These findings suggest that long‐term cardiovascular monitoring of patients with CVI is needed 36,37 …”