Lifestyle risk factors for lower limb venous reflux in the general population: Edinburgh Vein Study

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Abstract
Background Varicose veins occur commonly in the general population but the aetiology is not well established. Varicosities are associated frequently with reflux of blood in the leg veins due to valvular incompetence. Our aim was to determine in the general population which lifestyle factors were related to reflux and thus implicated in the aetiology of varicose veins. Methods In the Edinburgh Vein Study, 1566 men and women aged 18–64 years were sampled randomly from the general population in the city of Edinburgh, Scotland, and had duplex scans to measure reflux in eight venous segments in each leg. A self-administered questionnaire enquired about occupation, mobility at work, smoking, obstetric history, dietary fibre intake and bowel habit. A bowel record form was completed subsequently. Results In women, venous reflux was associated with decreased sitting at work (odds ratio [OR] = 0.76, 95% CI : 0.61–0.94), previous pregnancy (OR = 1.20, 95% CI : 0.93–1.54), and a lower prior use of oral contraceptives (OR = 0.84, 95% CI : 0.66–1.06). Mean body mass index was greater in women with superficial reflux compared to those with no reflux: 26.2 kg/m2 (95% CI : 25.5–27.0) versus 25.2 kg/m2 (95% CI : 24.8–25.6). On age adjustment, sitting at work remained related to reflux (OR = 0.78, 95% CI : 0.63–0.98) and prior use of oral contraceptives to superficial reflux (OR = 0.71, 95% CI : 0.50–1.01). In age-adjusted analyses in men, height was related to reflux, (OR = 1.13, 95% CI : 1.02–1.26) and straining at stool was related to superficial reflux (OR = 1.94, 95% CI : 1.12–3.35). No associations were found in either sex between reflux and social class, lifetime cigarette consumption, dietary fibre intake and intestinal transit time. Conclusions This population study did not identify strong and consistent lifestyle risk factors for venous reflux although previous pregnancy, lower use of oral contraceptives, obesity and mobility at work in women and height and straining at stool in men may be implicated.