Clinically Recognized Varicose Veins and Physical Function in Older Individuals: The ARIC Study

Abstract

Background: Although a few studies reported an association between varicose veins and physical function, this potentially bidirectional association has not been systematically evaluated in the general population.

Method: In 5 580 participants (aged 71-90 years) from the Atherosclerosis Risk in Communities study, varicose veins were identified in outpatient and inpatient administrative data prior to (prevalent cases) and after (incident cases) visit 5 (2011-2013). Physical function was evaluated by the Short Physical Performance Battery (SPPB, score ranging from 0 to 12). We evaluated (i) cross-sectional association between prevalent varicose veins and physical function, (ii) association of prevalent varicose veins with subsequent changes in physical function from visit 5 to visits 6 (2016-2017) and 7 (2018-2019), and (iii) association of physical function at visit 5 with incident varicose veins during a median follow-up of 3.6 years (105 incident varicose veins among 5 350 participants without prevalent cases at baseline).

Results: At baseline, varicose veins were recognized in 230 (4.1%) participants and cross-sectionally associated with reduced physical function. Longitudinally, prevalent varicose veins were not significantly associated with a decline in SPPB over time. In contrast, a low SPPB ≤6 was associated with a greater incidence of varicose veins compared to SPPB ≥10 (adjusted hazard ratio 2.13 [95% confidence interval = 1.19, 3.81]).

Conclusion: In community-dwelling older adults, varicose veins and low physical function were associated cross-sectionally. Longitudinally, low physical function was a risk factor for incident varicose veins, but not vice versa. Our findings suggest an etiological contribution of low physical function to incident varicose veins.

Keywords: Epidemiology; Physical function; Varicose veins.

Figure 1.

Adjusted hazard ratios (95% CI) of incident varicose veins by linear splines of SPPB with 2 knots (scores of 8 and 11). The results were adjusted for age (y), sex, race-ARIC field center, education levels (advanced vs intermediate vs basic), body mass index with spline terms and knots with 25 and 30 kg/m², systolic blood pressure (mm Hg), antihypertensive medication, diabetes, total cholesterol (mmol/L), HDL-cholesterol (mmol/L), lipid-lowering therapy, history of cardiovascular disease, history of deep vein thrombosis, current smoker, and current drinker. ARIC = Atherosclerosis Risk in Communities; CI = confidence interval; HDL = high-density lipoprotein; SPPB = Short Physical Performance Battery.

Figure 2.

Adjusted hazard ratios (95% CI) of incident varicose veins for poor physical function (SPPB ≤6 vs >6) by subgroups. The results were adjusted for age (y), sex, race-ARIC field center, education levels (advanced vs intermediate vs basic), body mass index with spline terms and knots with 25 and 30 kg/m², systolic blood pressure (mm Hg), antihypertensive medication, diabetes, total cholesterol (mmol/L), HDL-cholesterol (mmol/L), lipid-lowering therapy, history of cardiovascular disease, history of deep vein thrombosis, current smoker, and current drinker. ARIC = Atherosclerosis Risk in Communities; CI = confidence interval; HDL = high-density lipoprotein; SPPB = Short Physical Performance Battery.