Risk factors for varicose veins.

AIM: To determine the prevalence of varicose veins in the German population and specify possible risk factors the data of the Duesseldorf/Essen civil servants study were analysed. METHODS: From December 1989 to July 1993 a total of 9 935 employees were recruited. All volunteers filled out a questionnaire regarding family history and risk factors and were clinically examined. Venous findings were classified and adapted to the CEAP-classification. For the analysis of risk factors only volunteers classified as CEAP-class 0 or as CEAP-class II were considered: 4 250 men, 10% belonged to CEAP-class II and 2 380 women including 16% CEAP-class II. RESULTS: In general, age and gender were the most relevant risk factors for varicose veins. Odds ratio age: male: 3.4 (95%-CI: 2.6-4.4), age female 6.5 (95%-CI: 5.0-8.5), gender 2.3 (95%-CI 1.9-2.7). In addition in females the most frequent risk factors were oral contraception and in both genders a predominately sitting posture at work. Regarding the family history, varicose veins by the mother was most frequent compared to varicose veins by the father or both. After adjusting for age and gender heridity became the most important risk factor with an odds ratio of 5.2 (95%-CI:3.7-7.3-4.50) in case of varicose veins present in both parents, followed by a standing posture at work 2.2 (95%-CI: 1.2-3.9). In contrast, smoking also reached a significant level, but with a decreased odds ratio of 0.66 (95%-CI: 0.57-0.77) indicating a protective effect. CONCLUSION: In addition to age and gender a family history of varicose veins is the most important risk factor in the total population. Despite significant influence of other risk factors their relevance for varicose veins in the investigated population is low either due to low frequencies or low odds ratios.     

Prevalence of varicose veins of the lower limbs in the women working at a department store

The prevalence of varicose veins of the lower limbs and their risk factors were investigated in the group of 696 women working at a large department store. It was found that 421 of them suffered from varicose veins with the following prevalence of individual clinical types: trunk varices--14.4%, reticular varices--15.4%, and hyphenwebs--30.7%. In our study women with VV of all types compared to women without VV were older (p less than 0.05), more often obese (p less than 0.05), had the positive family history for VV (p less than 0.01), higher systolic and diastolic blood pressure and lower levels of physical activity (not significantly). Women with at least one pregnancy had significantly higher prevalence of VV (p less than 0.001) and women standing at their work had a higher prevalence of trunk varices than those who were sitting at the work (p less than 0.05).     

Prevalence and characteristics of muscle cramps in patients with varicose veins

BACKGROUND: It has been suggested that limb circulation may be disturbed in patients with muscle cramps due to leg venous hypertension. The aim of this study was to examine the incidence and characteristics of muscle cramps from venous insufficiency. PATIENTS AND METHODS: The incidence and characteristics of muscle cramps, which were investigated by a questionnaire, were compared between 288 patients with incompetence of the long or short saphenous vein and 550 age-matched individuals from the general population. RESULTS: The patient group showed a significantly higher incidence of muscle cramps in the last year than the general population group, 67% and 53%, respectively (p < 0.001). The incidence of calf cramps was significantly higher in the patient group than in the general population group, 91% and 75%, respectively (p < 0.001). Although most subjects reported symptoms occurring only at night, the incidence was significantly higher in the patient group than in the general population group, 78% and 52%, respectively (p < 0.001). There was no significant difference in the duration or severity of muscle cramps between the groups. The patient group showed a significantly higher incidence of more than 12 episodes per year than the general population group (p < 0.001). CONCLUSIONS: Muscle cramps in patients with varicose veins occur more frequently and more often at night and in the calf in comparison with those from the general population.     

Prevalence and risk factors for erectile dysfunction in Japanese diabetics

We evaluated the prevalence and risk factors for erectile dysfunction (ED) and interest in ED treatment among Japanese men being treated for type 2 diabetes mellitus. Patients (40-79 years; n=1118) completed the 5-item version of the International Index of Erectile Function (IIEF-5), and questions related to interest in ED pharmacotherapy, subjective symptoms of diabetes, and general quality of life. A separate survey completed by physicians examined the relationships between age, diabetic treatments (insulin or oral), symptoms of diabetes (poor glycemic control, microangiopathy), complications of diabetes (hypertension, ischemic heart disease, cerebrovascular disease), and ED. The prevalence of ED in patients with diabetes was 90%, a rate double that of non-diabetic individuals. Multivariate analyses revealed that age, insulin therapy, microangiopathy, hypertension, history of cerebrovascular or cardiovascular disease, leg dysesthesia, dysuria, insomnia, and anorexia all represented significant risk factors for ED. Half of all respondents were interested (29%) or would consider pharmacotherapy for ED (21%). These findings suggest that ED is a significant problem in Japanese men with diabetes, and that specific risk factors increase the prevalence of ED. Furthermore, the survey results expose national attitudes toward treatment of ED.     

Prevalence of retinopathy and its risk factors in a Japanese population

Aims/Introduction

To determine the prevalence and risk factors of retinopathy and validity of the current diagnostic cut‐offs for diabetes by using data of health check‐up examinees.

Materials and Methods

The study comprises 1,864 Japanese who participated in the general health check‐up program and did not have a previous history of cardiovascular disease. Non‐mydriatic 45° digital fundus photographs were taken twice annually. Multivariate logistic regression model was used to identify risk factors for retinopathy in participants without previously diagnosed diabetes.

Results

The overall prevalence of retinopathy in participants with and without previously diagnosed diabetes were 23.3% (28/120) and 4.2% (74/1,744), respectively. Univariate logistic regression analysis identified age, systolic blood pressure (SBP), fasting plasma glucose (FPG) and hemoglobin A1c (HbA_1c) as risk factors for retinopathy. Multivariate logistic regression analysis showed that FPG or both HbA_1c and SBP were significant, positive and independent risk factors for retinopathy. The prevalence of retinopathy increased with deterioration of glucose categories (P < 0.001 for FPG or HbA_1c). However, a statistically significant increased risk of retinopathy remained only in participants with FPG ≥ 7.0 mmol/L or HbA1c ≥ 6.5% compared with those with the lowest quartile of glucose in the participants without previously diagnosed diabetes after adjusting for age and SBP.

Conclusions

The prevalence of retinopathy was 4.2%, and FPG or both HbA_1c and SBP were positive and independent risk factors for retinopathy in health check‐up examinees without previously diagnosed diabetes. The FPG 7.0 mmol/L or HbA_1c 6.5% seems to be appropriate to diagnose diabetes in view of its association with retinopathy.     

Haemostatic factors and risk of varicose veins and chronic venous insufficiency: Edinburgh Vein Study.

Despite much research, the aetiology of venous disease is still poorly understood. Since haemostatic factors are involved in the processes of fibrinolysis and platelet aggregation, it is conceivable that such processes may be implicated in the pathology of varicose veins and chronic venous insufficiency (CVI). The Edinburgh Vein Study examined 1566 men and women aged 18-64 years that were randomly selected from the lists of 12 general practitioners. Each subject completed a questionnaire, underwent a comprehensive clinical examination and had a blood sample taken for the analysis of plasma fibrinogen, tissue plasminogen activator (t-PA) and von Willebrand factor (vWF) antigens. Subjects with trunk varicose veins and those with CVI had higher levels of each haemostatic factor compared with those with no trunk varices and no CVI. Although unit increases in t-PA and vWF were initially associated with a significantly increased risk of CVI in men, and both factors with an elevated risk of trunk varices in women, multiple adjustment for age, smoking status and body mass index reduced the odds ratios to non-significance. However, this does not entirely rule out the possibility of a pathogenic role for haemostatic factors in venous disease, but rather indicates the need for further experimental and epidemiological studies.     

Prevalence of main cardiovascular risk factors in women from Biscay

INTRODUCTION AND OBJECTIVES: The aim of this study was to analyze the prevalence of principal cardiovascular risk factors in the female population from Biscay (northern Spain). PATIENTS AND METHOD: We selected a random representative sample of 1,317 women aged between 16 and 65 years from this province. For each participant we recorded the following parameters: weight and height, physical activity, smoking, blood pressure, glycemia, total cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol. RESULTS: A total of 1,100 women (mean age 39.83 14 years) participated. Regarding physical activity, 31.9% of the women had a sedentary lifestyle and 48.4% did not exercise during leisure time. The prevalence of smoking was 31.9%. We found a mean body mass index of 24.9 4.6 kg/m2, and 42.4% of the women were overweight. The prevalence of hypertension was 13.1%, hypertension being defined as a mean systolic blood pressure > or = 160 mmHg, diastolic blood pressure > or = 95 mmHg, current antihypertensive treatment, or any combination of these criteria. When a cutoff value of > or = 140/90 mmHg was used, the prevalence increased to 26.7%. Total cholesterol values were > or = 240 mg/dl in 26.2%, triglyceride levels were > or = 200 mg/dl in 2.6%, LDL-cholesterol was > or = 160 mg/dl in 26.8%, and HDL-cholesterol values were < 45 mg/dl in 12.2%. The prevalence of hyperglycemia was 3.3%. CONCLUSIONS: The prevalences of main cardiovascular risk factors were similar to those in other Spanish studies. Except for smoking, the rest of these risk factors increased with age. Long-term measures should be adopted to modify dietary habits and lifestyles to obtain improvements in the cardiovascular risk profile.     

Treatment of varicose veins

Opinion statement  Varicose veins (VVs) are the most common manifestation of chronic venous insufficiency, affecting 25% of women and 15% of men. Reticular veins and telangiectasias (spider veins) are found in more than 80% of the general population. VVs produce symptoms of pain, swelling, heaviness, fatigue, and pruritus and predispose patients to complications including bleeding, superficial thrombophlebitis, and ulcerations that interfere with activities of daily living and result in lost time from work. Current treatments for VVs include conservative measures, and when these are unsuccessful, more invasive surgical and endovenous interventions primarily aimed at reducing venous hypertension and preventing progression to chronic inflammation and ulcerations. Surgical procedures including saphenous vein stripping, ligation of the saphenofemoral junction, and ambulatory phlebectomy are effective in the treatment of VVs but are associated with a high complication rate and recovery time. Emerging endovenous therapies, including endovenous laser therapy, radiofrequency ablation, and endovenous foam sclerotherapy, have shown similar efficacy in the treatment of VVs compared with more invasive surgical procedures, with lower complication rates and less time lost from work.     

Connective tissue in varicose veins

The collagen, elastin, total sugar, and nonscleroprotein content was evaluated in 32 samples of saphenous varicose vein and in 34 controls. A significantly lower collagen and elastin content was found in the varicose samples without correlation with the degree of pathologic broadening. Otherwise the total sugars and the soluble nonscleroproteins were found to be increased in varicose samples. The results are more significant when expressed as milligrams per surface unit of endothelium. Our data support the hypothesis that the decrease in collagen and elastin content is a primary rather than secondary change.     

Prevalence of and risk factors for sarcopenia in elderly Chinese men and women

BACKGROUND: Several studies have documented the substantial health and economic burdens associated with sarcopenia among the elderly, but there has been no systematic study among Asians. A cross-sectional survey of elderly community-dwelling Chinese volunteers (262 men and 265 women), aged 70 years and older, was undertaken in Hong Kong. The purposes of this study were to evaluate the prevalence of and risk factors for sarcopenia in elderly Chinese, and to compare these observations with those in white persons. METHODS: Muscle mass was estimated by dual-energy X-ray absorptiometry. In this study, sarcopenia was defined as a total adjusted skeletal muscle mass two standard deviations or more below the normal mean for young Asian men and women in this study. The relationship between risk factors (alcohol consumption, cigarette smoking, regular exercise, body mass index, medical conditions) and sarcopenia was studied by multiple logistic regression. RESULTS: The prevalence of sarcopenia was 12.3% in Chinese men and 7.6% in Chinese women aged 70 years and older, which was slightly lower than figures observed in white persons. Being underweight was a significant risk factor in both men (odds ratio, 39.1; 95% confidence interval, 11.3 to 134.6) and women (odds ratio, 9.7; 95% confidence interval, 2.8 to 33.8). No other risk factors were found in Chinese men or women. CONCLUSIONS: Sarcopenia exists among elderly Chinese men and women, albeit at a lower rate than in white persons. This may be due to the lower muscle mass among young men and women or to an attenuated rate of loss in muscle mass with aging in the Chinese elderly. Being underweight is a major risk factor for sarcopenia in both sexes.     

Prevalence and risk factors for cervical intraepithelial neoplasia among HIV-infected women

ObjectivesTo evaluate the prevalence and the risk factors for cervical intraepithelial neoplasia (CIN) among HIV-infected women.MethodsCross-sectional study of 494 HIV-infected women in Brazil, between 1998 and 2008. Gynecologic exam was performed, and samples were collected for cervical cytology and for HPV DNA detection. Cervical biopsy was carried out when indicated. HPV infection, CD4 T-lymphocyte count and HIV viral load were compared with cervical histopathology. Univariate and multivariate statistical analyses were performed to evaluate the statistical association of several risk factors.ResultsCIN prevalence detected by histopathology was 23.4% (6% of CIN2/3 and 17.4% cases of CIN1). Multivariate analysis confirmed an independent association of CIN with CD4 T-lymphocyte count below 200 cells/mm³ (OR 5.0, 95% CI 2.5–10.1), with a positive detection of HPV DNA (OR 2.0, 95% CI 1.2–3.5), and with age ≤ 34 years old (OR 1.5, 95% CI 1.0–2.4). HIV viral load and antiretroviral use were not independent risk factors for CIN.ConclusionsSeverity of immunosupression, presence of HPV infection and younger age are strong predictors of CIN among HIV-infected women.     

Incidence of varicose veins in Finland

BACKGROUND: Incidence of varicose veins in the population is unknown. The study aimed at estimating the incidence of varicose veins in complete cohorts of 40-60 year-olds in a general population. PATIENTS AND METHODS: The study was conducted in the city of Tampere, Finland. A validated questionnaire (with 93% sensitivity and 92% specificity) was used in a general population of 6874 individuals (aged 40, 50 or 60). Initially, 3065 of them had no varicose veins and 78% were followed-up for 5 years. RESULTS: 157 individuals reported new varicose veins during the follow-up. The overall incidence was 13.5 per 1000 person years (8.5 for men and 19.2 for women). Female sex was an independent and statistically significant risk indicator of varicose veins (adjusted odds ratio, OR 2.4). The incidence was significantly higher at the age of 50-55 years (OR 1.6). Higher body mass index seemed to be related to higher risk of new varicose veins (OR 1.2-1.8), but the association failed to reach statistical significance. The level of education did not affect the incidence. CONCLUSIONS: New varicose veins appear also in the middle-aged population, and the rate is linked with the female gender, especially at the beginning of the 6th decade.