Varicose Veins May Elevate Risk for All-Cause Dementia in Patients

Varicose veins are associated with an increased risk for all-cause dementia, with treatment for varicose veins likely to reduce risk for incident vascular dementia, according to study results published in PLOS One.

Given the widespread occurrence of varicose veins and dementia in the United States, exploring this link may help in the prevention and management of dementia.

Researchers determined whether varicose veins increased the risk for dementia, as well as the effect of varicose veins treatment/procedure on the occurrence of dementia.

Participants were enrolled in the study from the National Health Insurance Service-Health Screening (NHIS-HEALS) cohort database in South Korea between 2002 and 2019. Demographic information, such as age, sex, and other socioeconomic factors, including household income, body mass index (BMI), and smoking status, were collected. Participants with vs without varicose veins were propensity-score matched in a 1:5 ratio.

Diagnoses of varicose veins and all-cause dementia were ascertained using the International Classification of Diseases, Tenth Revision (ICD-10) codes.

Primary outcome of the study was all-cause dementia, including Alzheimer disease (AD), vascular dementia, and other types of dementia. Secondary outcomes were occurrence of AD and vascular dementia.

A total of 396,767 individuals (mean age, 56.1 years; men, 46%) were considered for the current analysis.

The varicose veins vs non-varicose veins group had a higher percentage of men, higher BMI, and more comorbidities, but a lower frequency of smoking, alcohol consumption, and history of diabetes.

A total of 55,329 (13.9%) cases of dementia, 38,673 (9.7%) cases of AD, and 15,013 (3.7%) cases of vascular dementia occurred during a median follow-up of 13.33 years.

Results of the multivariate analysis showed that patients with vs without varicose veins have an increased risk for all-cause dementia before (hazard ratio [HR], 1.241; 95% CI, 1.170-1.316) and after propensity-score matching (HR, 1.235; 95% CI, 1.147-1.329; both P <.001). Of note, varicose veins were not found to be associated with AD and vascular dementia.

After adjusting for covariates, the presence of varicose veins was associated with incidence risk for all-cause dementia. Compared with women, noncurrent smokers, and nonheavy drinkers, those who were men, current smokers, and heavy drinkers had a greater risk for incident all-cause dementia. Overall, the association between varicose veins and incidence risk for all-cause dementia remained significant before (HR, 1.250; 95% CI, 1.178-1.326; P <.001) and after propensity-score matching (HR, 1.218; 95% CI, 1.131-1.312; P =.041).

Consistent results were observed on using a 1:3 matching ratio (HR, 1.220; 95% CI, 1.140-1.305) and in a sensitivity analysis using a competing risk model.

In assessing secondary outcomes, incidence risk for all-cause dementia with and without treatment/procedure between the 2 groups before (HR, 0.884; 95% CI, 0.778-1.005) and after propensity-score matching (HR, 0.920; 95% CI, 0.796-1.062) were similar. However, the researchers noted a decreased risk for AD before (HR, 0.778; 95% CI, 0.624-0.970) but not after propensity-score matching (HR, 0.787; 95% CI, 0.615-1.007), and a decreased risk for vascular dementia both before and after propensity-score matching (HR, 0.630; 95% CI, 0.437-0.908 and HR, 0.566; 95% CI, 0.382-0.841, respectively).

Limitations of the analysis included a lack of accounting for severity of varicose veins; not including unmeasured confounders, such as education, family history of dementia, and genetics; and claims data not including cognitive assessment, lab tests, and imaging studies.

The researchers concluded, “Our study showed that presence of [varicose veins] may be associated with an increased risk of future all-cause dementia, and treatment of [varicose veins] was likely to reduce the incidence risk of [vascular dementia].”