A GLOBAL APPROACH OF WORLD EMIDEMIOLOGY IN

CHRONIC VENOUS DISORDERS

Dr M. Cazaubon et Pr FA. Allaert

Global Approach in CVD

•1/ Incidence

•2/ Prevalence•3/ Risk factors

1/ INCIDENCE CVD

• The only follow-up study• 2-year incidence rate of varicose

veins =• 39 per 1000 men-years • 52 per 1000 women years (40-89 years of age)

FRAMINGHAM STUDY BRAND et al. Am J Prev Med 1988

2/ PREVALENCE CVD

MANY STUDIES

Variations in prevalence of varicose veins

• Prevalence of varicose veins worlwide

= 0,1% in women from villages in rural New Guinea

= 60,5% in women working in a department store in Czechoslovakia

• Necessity to compare similar studies with the same methodology

Studies with similar methodology for varicose veins

in female

Location Age Method % VV

Jerusalem >15 examination 29,5 %

Finland = TEMPERE

>30 questionnaire 25 %

Edimburgh 18-64 y Examination 32,2 %

PREVALENCE VARICOSE VEINS

In Western Countries

25 % à 33 %

10 % à 20 %

PREVALENCE OF VARICOSE VEINS

IN DEVELOPING COUNTRIES Location Number Prevalence

In male

Prevalence in female

Cook Island

Pukapukas

377 2,1 4

Cook Island

Rarotongas

417 15,6 14,9

New Guinea 1457 5,1 0,1

Tanzania 1000 6,1 5,0

3. RISK FACTORS

• FAVOURITES – Gender – Heredity– Pregnancies

• OUTSIDERS– Standing at work– Obesity – Height– Constipation, fiber

intake……– Hormonal therapy– Ethnicity

A/ GENDER and varicose veins

Location Nb. Age Women Men

Greece 99 567 43-87 20,3 7,0

Italian 98 1319 66-97 35,2 17,0

Tecumseh 02 >10 25,9 12,9

Brazil 86 1755 >15 50,9 37,9

Edinburgh 99 1600 18-64 32,2 39,7

B. HEREDITYand varicose veins

Study Methodology Nb patients OR

TEMPERE(02)

Population

Questionnaire

Multivariate analysis

7000 4,9

ESSEN (04)

Cross sect.

Questionnaire and examination

Multivariate analysis

9935 5,2

B . HEREDITYand CVD

• 4294 women with CVD – 49% of their children have venous disorders

• % of children with CVD and mothers’class of CEAP– C4 or > C4: 69% – C3: 60% – C2 : 56%– C1: 43 % FA ALLAERT AVF 2003

CC.Number of pregnancies and CVD

0

5

10

15

20

25

30

35

40

0 1 2 3 4 5and >5

CVI+CVI -

Jawien et al. Phlebology 2004

C.Number of pregnancies ( P) and CVD

• 1 P OR= 1,3• 2 P OR = 1,4• 3 P OR = 1,6• 4 P OR = 1,9• >5 P OR = 2,2

Bonn study Bromen and Rabe 2004 (Population study )

Others Risk factors

Standing at work

Obesity Height

Constipation, fiber intake……

Hormonal therapy

Ethnicity Epidemiology of CVD. M Cazaubon FA ALLAERT in Sclérotherapy of varicose veins ( ESKA 2005 in press)

VARICOSE VEINS IN TROPICAL AFRICA

• Prevalence of varicose veins in Tanzania

6,1% in men 5,0 % in women • Prevalence of

telangiectasia and varicose veins :

• 0,12% Ouganda*• 11% women in

Mali**Burkitt 1972* Rougement Lancet 1974** **

Prevalence of venous disorders and ethnicity

Non-Hispanic Whites have more venous disorders than :

• Hispanics, • African Americans • AsiansSan Diego Study Criqui Am J Epidemiol 2003

Visible disease and ethnicity in San Diego Study

Ethnicity Normal Spider veins

Varicoseveins

Trophic changes

Non

Hispanic

White

14,3 54,8 24,0 6,9

Hispanic 18,9 50,0 26,3 4,7

African-american

27,7 45,3 20,8 6,3

Asian 31,1 45,4 18,7 4,8

Chronic Venous Disorders in patients from emerging

countries, living in France

Survey conducted by 70

angiologist

F-A. ALLAERT M CAZAUBON and SFA

Professeur adjoint Dpt. d’Epidémiologie et de Santé Publique, Université MacGill, Montréal, Canada.

CENBIOTECH, CHRU Dijon.

Patients description

Nombre de patients vus par semaine pour une affection veineuse chronique

23,2%

31,9%

44,9%

0%

10%

20%

30%

40%

50%

60%

Moins de 20 (n=16) De 20 à 50 (n=31) Plus de 50 (n=22)

Patients description

Proportion des patients des pays émergents présentant une affection veineuse chronique

74,3%

1,4%

10,0%14,3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

<10% (n=52) 10 à <25% (n=10) 25 à <50% (n=7) >50% (n=1)

Patients description

Ethnies concernées par une affection veineuse chronique

22,9%18,6%

21,4%

85,7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Patients d'afrique centrale(n=16)

Patients maghrébins (n=60) Patients asiatiques (n=15) Patients du moyen orient(n=13)

Clinical description of CVD using the CEAP classification

Classes CEAP les plus fréquemment classée en 1 ou 2éme position

42,4%

16,4%

68,3%

81,2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

C1 : Télangiectasies (n=25) C2 : Veines variqueuses(n=56)

C3 : Oedèmes (n=43) C4 : Troubles trophiques(n=9)

Risk factors

Facteurs de risque le plus souvent présent chez ces patients

92,9%

58,6%

28,6%

44,3%

72,9%

58,6%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Sexe féminin(n=65)

Age > 35 ans(n=41)

Obésité ou prisede poids (n=51)

Grossesse (n=41) Travail debout ouassis prolongé

(n=20)

Antécédentsfamiliaux de

varices (n=31)

Treatment modalities

Prise en charge le plus souvent proposée à ces patients

82,9%78,6%

64,3%

47,1%

90,0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Régles hygiéno-diététiques (n=58)

Compression (n=63) Veinotoniques (n=33) Sclérothérapie (n=55) Traitementchirurgical (n=45)

Conclusion of the study

• CVD are present in all people living in France , and coming from emerging country

• Role of «  environnemental » factors in immigrant people  and ???genetic

• They are consulting late, and we find the most severe class of CVD

CONCLUSION

•It is necessary to develop a very sharp «  chronic venous disorders consciousness »

•To prevent it ( risk factors)

•To diagnose it early and •For the appropriate treatment

•

2: CEAP CLASSIFICATION = COMPASS

C

E

A

P

A - asymptomatic S - symptomatic

C - congenitalP - primaryS - secondary

S - superficialD - deepP - perforatorsR - refluxO - obliterationR,O - reflux and obliteration

Ad Hoc Committee, American Venous Forum, Hawai 1994

•In all the world •That is the aim of our observatory of chronic venous diseases