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Varicose vein is associated with an increased risk of ischemic stroke: a population-based matched cohort study
Feng-Renn Hsieh1,2, Wei-Kai Lee3, Sunny Ssu-Yu Chen4,5
1Department of Emergency Medicine, Kaohsiung Municipal United Hospital, No. 976, Jhonghua 1st Rd., Gushan Dist., Kaohsiung City 80457, Taiwan.
Insights
Varicose veins (VVs) increase the risk of ischemic stroke, particularly in individuals over 50. Managing VVs may help reduce this stroke risk, highlighting the need for integrated care.
Area of Science:
- Vascular Medicine
- Neurology
- Epidemiology
Background:
- Varicose veins (VVs) are associated with cardiovascular diseases, but their direct link to stroke risk and the effect of treatment remain under investigation.
- Existing research has not clearly established whether managing VVs influences stroke incidence.
Purpose of the Study:
- To determine if varicose veins (VVs) are associated with an increased risk of stroke.
- To assess the impact of interventions for VVs on the subsequent risk of stroke.
Main Methods:
- A propensity score-matched cohort study was conducted using data from 2000-2015, excluding patients with prior strokes.
- Adults with VVs were compared to a matched cohort without VVs, with follow-up until 2018.
- Cox proportional hazards models were used to analyze the incidence of ischemic stroke (IS) and hemorrhagic stroke (HS).
Main Results:
- The study identified a higher incidence rate of IS in the VV group compared to the non-VV group (13.15 vs. 11.16 per 1000 person-years).
- Individuals with VVs had a significantly increased risk of overall stroke (aHR=1.16), with elevated IS risk observed in both females and males, and in those aged 50 and above.
- No significant association was found between VVs and HS; however, sensitivity analyses suggested that VV management might reduce stroke risk (aHR=0.82).
Conclusions:
- Adults with varicose veins (VVs) face a higher risk of ischemic stroke (IS), but not hemorrhagic stroke (HS).
- The findings suggest that interventions for VVs could potentially lower the risk of stroke.
- Healthcare providers should consider stroke risk assessment and VV management in older patients for enhanced preventive care.
Importance:
The association between varicose veins (VVs) and stroke, and the influence of VV management on the risk of stroke remained unclear.
Objective:
To evaluate whether VVs are associated with an elevated risk of stroke and assess if interventions for VVs alter this risk.
Design:
From 1 January 2000 to 31 December 2015, adults with VVs were matched by propensity score with those without VVs. Patients with prior strokes were excluded. Follow-up continued until 31 December 2018.
Outcomes:
Relative hazards through comparing incidence rates of ischemic stroke (IS) and hemorrhagic stroke (HS) between the two groups using Cox proportional hazards models.
Results:
Comparison of the VV group (n = 23 238, mean [SD] age = 54.3 [15.6] years; 70% female) with the non-VV group (n = 92 952, mean [SD] age = 54.1 [15.7] years; 71% female) revealed a higher incidence rate of IS in the former than the latter (13.15 vs. 11.16 per 1000 person-years; 2555 vs. 8799 cases, respectively). The adjusted hazard ratio (aHR) for overall stroke in the VV group was 1.16 (95% CI = 1.11-1.21). Both females (aHR = 1.18 [95% CI = 1.11-1.25]) and males (aHR = 1.15 [95% CI = 1.07-1.24]) with VVs showed an increased IS risk. In patients aged ≥50, VVs were associated with a higher IS risk (aHR = 1.17 [95% CI = 1.12-1.23]). No significant correlation was found between VVs and HS. The association of VV management with a reduced risk of stroke (aHR = 0.82 [95% CI = 0.70-0.96]) was supported by sensitivity analyses.
Conclusions:
Adults with VVs showed an increased risk of IS but not HS. Key message What is already known on this topic. Varicose veins (VVs) are linked to cardiovascular conditions, but their association with stroke risk and the impact of VV interventions remain unclear. What this study adds. This study demonstrated that adults with VVs, especially those aged ≥50, have a higher ischemic stroke (IS) risk. VV interventions may reduce this risk. How this study might affect research, practice, or policy. Stroke risk assessment and VV management should be considered in older patients to improve preventive care.
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