The influence of obesity on chronic venous disease

The authors investigate the impact of overweight in patients with chronic venous disease and determine if the eventual effect can be explained by increased venous reflux alone. Patients with chronic venous disease who underwent duplex-ultrasound scanning at the Vascular Center, Straub Clinic and Hospital during 1999 were classified according to the clinical, etiologic, anatomic, and pathophysiologic (CEAP) system and body mass index (kg/m(2)) was calculated. Reflux duration was measured in seconds and peak reverse flow velocity in cm/second. Multi-segment reflux score (total score) was calculated for both reflux duration and peak reverse flow velocity. The reflux pattern and body mass index were correlated to the clinical presentation. Four hundred and one lower extremities (204 right, 197 left) in 272 patients (173 female) with a mean age of 60 years (range 14-90) were investigated. The mean body mass index was 28.9 (+/-7.76). One hundred sixty-seven patients (61%) were overweight (body mass index 25 kg/m(2) or more). There was a significant association between body mass index and the clinical severity (p<0.001). This association persisted after adjustments for total peak reverse flow velocity and total reflux score were made (p<0.001). Overweight patients were more likely to have skin changes and ulceration (p<0.001) than patients with a body mass index less than 25 kg/m(2), despite similar values for total reflux time (p=0.92) and total peak reverse flow velocity (p=0.98). There was an ethnic difference, with Pacific Islanders being significantly heavier and younger compared to patients of white, Asian and Filipino ancestries. The variations in the frequency of skin changes were consistent with ethnic differences in body mass index. The correlation of body mass index with clinical severity independent of reflux measurements indicates that the effect of overweight may involve a mechanism separate from local effects on venous flow. Overweight appears to be a separate risk factor for increased severity of skin changes in patients with chronic venous disease.