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

Educational Objective
To learn whether patients with varicose veins may be at increased risk of venous thrombosis, pulmonary embolism, or peripheral artery disease.
1 Credit CME
Key Points

Question  Are varicose veins associated with an increased risk of developing deep venous thrombosis (DVT), pulmonary embolism (PE), or peripheral artery disease (PAD)?

Findings  In this retrospective cohort study from Taiwan that included 425 968 adults, the presence of varicose veins was associated with a significantly increased risk of incident DVT (hazard ratio [HR], 5.30), PE (HR, 1.73), and PAD (HR, 1.72).

Meaning  This study found a significant association between varicose veins and DVT, and less clear potential associations with PE and PAD; further research is needed to understand whether the association with DVT is causal.

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.

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Article Information

Corresponding Author: Pei-Chun Chen, PhD, Department of Public Health, China Medical University, No. 91 Hsueh-Shih Rd, Taichung, Taiwan 40402 (peichun@mail.cmu.edu.tw).

Accepted for Publication: January 18, 2018.

Author Contributions: Drs S-L Chang and Chen had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: S-L Chang, Huang, Lee, Hu, Chen.

Acquisition, analysis, or interpretation of data: S-L Chang, Hsiao, S-W Chang, CJ Chang, Chen.

Drafting of the manuscript: S-L Chang, Lee, Hu, Chen.

Critical revision of the manuscript for important intellectual content: S-L Chang, Huang, Hsiao, S-W Chang, CJ Chang, Chen.

Statistical analysis: S-W Chang, Chen.

Obtained funding: S-L Chang, Huang, CJ Chang.

Administrative, technical, or material support: Lee, Hsiao, S-W Chang, CJ Chang.

Supervision: Hu, CJ Chang, Chen.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Funding/Support: This study was supported by grants from Chang Gung Medical Research Program (CIRPD1D0032) and from the Taiwan Ministry of Science and Technology (MOST 103-2314-B-002 -038 -MY3).

Role of the Funder/Sponsor: Chang Gung Medical Research Program and Taiwan Ministry of Science and Technology had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank Shu-Ru Lee, MS, (Research Services Center for Health Information, Chang Gung University, Taoyuan, Taiwan), for data analysis assistance. Ms Lee was not compensated for her contribution.

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