Risk Factors for Vein Disease: Changing the Things You Can
What’s the likelihood that you might suffer from symptoms of venous (vein) disease, such as varicose veins, leg heaviness, or restless leg syndrome? There are a number of risk factors for vein problems that can be divided into two general categories: those you can’t control (biological) and those you can (environmental).
Let’s start with aging— a factor we all probably wish we could control! As people age, vein issues become more prevalent. Small problems that started earlier, often progress into larger ones. A decrease in the body’s production of collagen causes veins to become less elastic and more likely to “leak,” especially superficial veins. This is why there’s an increase of varicose veins in the elderly population.
It’s worth noting that even though seniors have a fifty percent greater chance of suffering from venous insufficiency, there is no research to suggest that their success rates after venous treatment are different from the their younger peers. In fact, the risk-benefit ratio makes treatment an ideal option for seniors.
All in the family
Although all the research that supports a genetic link in varicose veins is based on patient recall and may have bias, there has been significant research with gene mapping that shows there is definitely a genetic component to venous disease.
If someone in your family has experienced vein disorders or has visible veins on their legs, your risk of the disease is much higher. Since venous disease does have a strong genetic component, it’s important to be aware of venous disease and its symptoms and, as with any illness, to know the family history.
As with heredity, ethnicity also plays a role. Non-Hispanic whites have a higher incidence of varicose veins when compared with the Hispanic population and the African Americans, and Asians.
Gender definitely plays a role in varicose veins and other vein issues. Women are almost 2½ times more likely to have vein disease than men. A woman has three “high risk” times in her life that men do not.
- First when she gets her period; during menarche, hormone surge is very common. Progesterone can act as a vasodilator— a hormone that opens blood vessels— causing veins to stretch significantly, sometimes to the point of damaging them.
- Something similar happens in the first trimester of pregnancy. This is why it is so critical for women with family histories of venous disease to wear compression stockings as soon as they starting thinking about becoming pregnant— or most importantly, through the first trimester of pregnancy. Although the third trimester may carry some risk of developing varicose veins due to increased abdominal pressure and blood volume, the damage seems to happen in the first trimester.
- Finally, when a woman enters menopause, vein damage can occur due to hormonal surges similar to those in menarche and pregnancy.
Environmental awareness
While venous disease has a strong genetic and biological component, it can be aggravated by environmental risks. It is much more common in “industrial countries” like the U.S., where riding in cars and sitting in front of a computer or television seem like a way of life.
The ability to move the ankle, known as ankle motility, is important to consider. The calf muscle acts as a pump to push blood in the leg— against gravity— from the leg, back up to the heart. If the ankle does not have full range of motion, it is considered an independent risk factor for venous disease. For this reason, high-heeled shoes are often associated with bad veins. When one is wearing high heels, the calf muscle cannot be fully extended, which decreases its power within the pumping mechanism.
Standing for long periods, with or without high heels, is also a risk factor. Research has shown that the more hours one stands, the more likely it is that a vein issue will develop. Likewise, sitting or lying in one position for too long can cause serious vein problems. Patients in the hospital or on bed rest, for example, may experience a slowdown in blood flow that can lead to blood pooling in the extremities. One possible risk caused by prolonged immobility is deep vein thrombosis (DVT), which is a blood clot that forms in the deep vein system. Another risk is superficial thrombophlebitis, which is a blood clot that forms in the superficial system. Both types of clots can damage the valves and result in venous reflux or insufficiency.
At my practice, many patients have asked if crossing their legs causes varicose veins. The answer is: we don’t currently know. There is no research supporting this claim, but anecdotally, I occasionally see a patient who crosses her right leg over the left who experience issues with their small saphenous, a vein that begins at the back of the knee and extends down the backside of the leg. Continuous pressure on this vein may damage the valves, or at least impede flow, which could create permanent damage.
People often assume that weight is a risk factor in venous disease. However, weight, obesity, waist measurements, and BMI (Body Mass Index) have conflict in research. There have been several studies that show a connection and several others that don’t. One study found a connection between BMI and superficial vein disease but not deep vein issues. Again, there has not yet been conclusive research about this.
In some cases, such as family history or ethnicity, it is impossible to eliminate risk factors for vein disease. Some risk factors, however, can be reduced. There are many treatment options today that are minimally invasive and highly successful, but education and prevention are the most important keys to good vein health.
Dr. Cindy Asbjornsen is the founder of the Vein Healthcare Center in South Portland, Maine. Certified by the American Board of Venous and Lymphatic Medicine, she cares for all levels of venous disease, including spider veins, varicose veins and venous ulcers. She is the only vein specialist in Maine to be named a Fellow by the American College of Phlebology. You can contact Dr. Asbjornsen at 207-221-7799 or: [email protected].
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