Risk Factors For Cpvd

We have completed an extensive analysis of risk factors for visible and functional CPVD.8 Table 3.3 summarizes this work and shows odds ratios for significant predictors of visible and functional venous disease in our population.

Age was positively consistently related to all levels of visible and functional disease in both sexes. In comparison with non Hispanic whites (NHW), African-American Asian had less TSV and VV in both sexes, less TCS in men, and less DFD in women. Our results thus confirm that older age and NHW ethnicity are risk factors for CPVD.

Family history of venous disease based on subject recall was a risk factor for all levels of visible and functional disease. Although this finding could be biased, it is consistent with many other studies,9,10 although not all.11

Ankle motility was a risk factor for visible disease SFD in women and for TSV in men. It was protective for women with DFD and men with SFD. The association of increasing laxity in connective tissue with venous disease corroborated previous research (reviewed in Reference 8). The protective associations could reflect increased ankle motility leading to decreased venous pressure by increasing pumping action.

Lower limb injury was a risk factor in women for DFD. Coughlin et al., in a case-control study, found serious lower limb trauma to be a risk factor for CVI.11

CVD-related factors, such as angina, PTCA, hypertension, and diastolic pressure were associated with less TSV, SFD, and DFD for men and women and less VV for men. Although some studies have found a relationship between atherosclerosis and venous disease (reviewed in Reference 8), others have not.9 The reason for any protective effect of cardiovascular disease and hypertension on CPVD is not readily apparent, although venous vaso-

constriction and microthrombosis could conceivably be involved.

Hours spent walking or standing was positively associated with VV, TCS, and SFD in men and women. Fowkes et al.12 found that walking was a risk factor for women with venous insufficiency when age-adjusted, but less so when multiply adjusted. They found walking to be related to lessened risk of venous insufficiency in men.12 Our data indicate that standing was a strong risk factor for venous disease in women. This is concordant with a number of studies,9,10 and contrasts with some other studies.12

Weight, height, waist, and BMI, defined as weight in kg divided by height squared in meters squared, were positively associated with TCS, and DFD in men and VV, TCS, and SFD in women. Weight, waist circumference, the waist/hip ratio, and body mass index are all measures of adiposity. A number of studies have found an association of obesity with venous disease. Gourgou et al.10 found a relationship in both men and women with VV. Our finding of increased waist circumference in men with TCS was consistent with findings that both obesity and male gender were associated with CVI and with the finding that weight was an independent risk factor for CVI in multivariate analysis (reviewed in Reference 8). In contrast, Coughlin et al. and Fowkes et al. both found that obesity was not a factor in venous insufficiency among women.11,12 Fowkes et al. extended this finding to men as well.12 Other studies also have found no association between obesity and venous disease.9 However, the Edinburgh group also found that for men and women combined, persons with greater severity of varices (i.e., more segments with reflux) had higher body mass indices than those with fewer segments involved. Additionally, Fowkes et al. found that varicosities in the superficial system, but not in the deep system, were related to body mass index in women.12

Exercise was associated with lower rates of TSV, TCS, and SFD in men. This is concordant with the finding of

Symptoms and CPVD

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