Varicose veins are associated with a significantly increased risk of incident deep venous thrombosis (DVT) risk, though pulmonary embolism (PE) and peripheral artery disease (PAD) are unclear, according to a study published in JAMA.

Shyue-Luen Chang, MD, of the Vein Clinic of the Department of Dermatology at Chang Gung Memorial Hospital in Taoyuan, Taiwan, and colleagues, conducted a retrospective group analysis to assess the possible correlation between varicose veins and risks for DVT, PE, and PAD development.

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The investigation included a total of 425,968 participants—aged 20 or older—who presented with varicose veins (n=212,984) or control group participants (n= 212,984) without varicose veins and were matched with a given propensity score. Individuals who were diagnosed with DVT, PE, or PAD before the commencement were ineligible for the study.

The primary outcome was the incidence rate of DVT, PE, and PAD in patients with and without varicose veins. Diagnoses were determined by at least 2 outpatient visits or 1 hospital admission with the proper diagnosis codes. Participants who developed one of the studied conditions and later developed another of the monitored conditions were recorded for 2 separate cases.

The participants with varicose veins predominantly consisted of women (69.3%), and the group average age was 54.5 years. Control cohort participants (70.3% women) had an average age of 54.3 years.

Follow-up examination was required for all participants in both groups. In the case group, median follow-up durations were 7.5 (DVT), 7.8 (PE), and 7.3 years (PAD), while the control group had follow-up years of 7.6 (DVT), 7.7 (PE), and 7.4 (PAD).

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The case group had a greater incidence rate for all 3 primary outcomes with absolute risk differences (ARD) of 5.32 for DVT, 0.20 for PE, and 4.51 for PAD. Hazard ratios for the case group compared to patients without varicose veins were 5.30 for DVT, 1.73 for PE, and 1.72 for PAD.

“The magnitude of the association between varicose veins and PE and PAD was small, and therefore, it may more likely be due to residual or unmeasured confounding,” the authors reported. “Whether the association between varicose veins and DVT is causal or represents a common set of risk factors requires further research.”


  1. Chang S, Huang Y, Lee M, et al. Association of varicose veins with incident venous thromboembolism and peripheral artery disease. JAMA. 2018 Feb 27. doi:10.1001/jama.2018.0246