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Published on: December 9, 2022
The Clinical Course of Chronic Venous Disease
Safa Salim1, Matthew Machin1, Mahsa Mazidi2
1Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.
Summary
Chronic venous disease (CVD) has varied clinical signs, from varicose veins to ulcers. While some factors like obesity and pregnancy increase risk, patients with varicose veins rarely progress to ulcers, suggesting distinct disease pathways.
Area of Science:
- Vascular Medicine
- Epidemiology
- Health Informatics
Background:
- Chronic venous disease (CVD) encompasses a spectrum of conditions, including varicose veins (VV) and venous ulceration (VLU).
- Understanding the clinical course and associated factors of CVD is crucial for effective management.
Purpose of the Study:
- To evaluate the clinical course of chronic venous disease (CVD) using electronic healthcare records (EHRs).
- To identify factors associated with the development and progression of CVD manifestations.
Main Methods:
- Retrospective, longitudinal study utilizing data from national electronic healthcare records (EHRs).
- Nested case-control study design to analyze factors linked to CVD development.
- Machine learning analytics applied to a large cohort of 890,982 cases.
Main Results:
- Varicose veins (VV) are associated with overweight, pregnancy, and hormonal therapies.
- Venous ulceration (VLU) is linked to White ethnicity, male sex, obesity, frailty, and prior venous thromboembolism.
- CVD risk increases with cardiovascular conditions; vitamin D deficiency is associated with VLU. Progression from VV to VLU occurs in 1-2% of patients over a median of 7 years. VLU significantly increases mortality risk (HR 1.39) and recurrence rates (23%).
Conclusions:
- Common risk factors exist for different CVD manifestations, but VV and VLU represent phenotypically distinct patient groups.
- Progression from VV to VLU is infrequent, indicating that other etiological factors influence disease heterogeneity.
- Further research into underlying causes is needed to explain the varied clinical presentations of superficial venous reflux.
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