A GLOBAL APPROACH OF WORLD EMIDEMIOLOGY IN CHRONIC VENOUS DISORDERS Dr M. Cazaubon et Pr FA. Allaert
Dec 23, 2015
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