The cardiovascular impact of chronic venous disease: A systematic review and meta-analysis

To systematically evaluate the association between chronic venous disease (CVD) and cardiovascular (CV) risk, including major CV events and traditional risk factors, across diverse populations and study designs.

A systematic review was conducted following PRISMA guidelines. PubMed, Scopus, and Web of Science were searched from January 2011 to March 2025 using Medical Subject Headings terms and free-text keywords. Inclusion criteria encompassed observational human studies evaluating the relationship between CVD and CV outcomes or risk factors. Data extraction was performed independently by two reviewers. Thematic analysis and coding of extracted data were supported using ATLAS.ti software. Twenty studies met the inclusion criteria, including cohort, cross-sectional, and case-control designs.

Seventeen of the 20 studies (85%) reported a significant association between CVD and at least one CV outcome, such as coronary artery disease, stroke, peripheral arterial disease, heart failure, or CV mortality. Odds and hazard ratios ranged from 1.3 to 3.8, with higher Clinical-Etiological-Anatomical-Physiological classes (C3-C6) consistently linked with greater CV risk. Eight studies identified greater higher prevalence of traditional risk factors-including hypertension, diabetes, obesity, and dyslipidemia-in patients with CVD. Two studies provided mechanistic insights, highlighting systemic inflammation and endothelial dysfunction as potential shared pathways. Population-based analyses with multivariable adjustments confirmed the independent nature of the association. A meta-analysis of six studies encompassing 393,875 individuals and 55,356 CV events was conducted. The pooled odds ratio for CV events in patients with CVD was 0.92 (95% confidence interval, 0.14-1.69), reaching statistical significance (P = .021). An adjusted expected odds ratio of 2.50 (95% confidence interval, 1.15-5.44) further reinforced the strength of the association. Heterogeneity was high (I² = 98%), but no publication bias was detected. Visual exploration through Galbraith, L'Abbé, and funnel plots supported the consistency of the findings.

CVD is independently associated with increased CV morbidity and mortality, particularly in patients with moderate to severe disease. These findings suggest that CVD may serve as a clinical marker of systemic vascular dysfunction and support its inclusion in CV risk assessment frameworks. The quantitative synthesis confirms a significant association and highlights the importance of early CV screening in patients with CVD.