Venous disease is commonplace, more prevalent in women, increases with age, and is a major cause of morbidity. Between 6 and 30% of all medical expenditures for cardiovascular disease are for venous disease. Despite these facts, the basic epidemiology of venous disease has received limited attention. Even the definition of peripheral venous disease varies widely, often confusing symptoms and signs with demonstrable pathophysiologic abnormalities. The proposed project has four specific aims. The first specific aim is to determine the overall, and age, sex, and ethnic-specific, prevalence of peripheral venous disease in a stratified multiethnic random sample of 400 men and women aged 40-79 years. Three specific categories of venous disease will be defined: 1) telangiectasias and flat reticular veins; 2) superficial venous disease without deep valvular incompetence or obstruction; 3) deep venous disease, with valvular incompetence or obstruction. Varicose veins are typically but not invariably present in the latter two categories. These three categories will be diagnosed by an ordered non-invasive evaluation, including visual inspection, with photographic documentation of abnormal findings, and duplex color sonography to diagnose valvular incompetence and venous obstruction. The second specific aim is to evaluate the sensitivity, specificity, and predictive value of each f the traditional signs and symptoms of venous disease for each of the three categories of venous disease signs and symptoms to be evaluated include aching, itching, swelling and edema, heaviness, cramps, nocturnal restless legs, pigmentation, induration, ulcers, and the Trendelenburg test. The third specific aim is to evaluate risk factors for each of the above three categories-of venous disease. Risk factors to be assessed include age; sex; ethnicity; socio- economic status; height; weight; obesity; exercise; blood pressure; standing vs. sitting in daily activities; family history of venous disease; cigarette smoking; alcohol consumption; diet; constipation; constrictive clothing; aspirin use; use of selected other medications; history of hernia, flat feet, or other conditions associated with connective tissue laxity; parity; se of estrogens or progestins; age at menarche; age at menopause; and concomitant arterial disease. The fourth specific aims is to evaluate the degree of morbidity and interference with daily activities resulting from venous disease, using the Quality of Well Being (QWB) scale developed at UC San Diego. This study should provide accurate estimates of the extent of peripheral venous disease, contribute to more efficient diagnosis, allow insight on how to prevent or ameliorate this condition through risk factor modification, and will provide quantitative estimates of the daily burden this disease imposes on patients.
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