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 LocationAgeMethod% VV Jerusalem>15examination29,5 % Finland = TEMPERE >30questionnaire25 % Edimburgh18-64 yExamination32,2 %

PREVALENCE VARICOSE VEINS In Western Countries 25 % à 33 %  10 % à 20 % 

PREVALENCE OF VARICOSE VEINS IN DEVELOPING COUNTRIES LocationNumberPrevalence In male Prevalence in female Cook Island Pukapukas 3772,14 Cook Island Rarotongas 41715,614,9 New Guinea14575,10,1 Tanzania10006,15,0

3. RISK FACTORS FAVOURITES –Gender –Heredity –Pregnancies OUTSIDERS –Standing at work –Obesity –Height –Constipation, fiber intake…… –Hormonal therapy –Ethnicity

A/ GENDER and varicose veins LocationNb.AgeWomenMen Greece ,37,0 Italian ,217,0 Tecumseh 02>1025,912,9 Brazil >1550,937,9 Edinburgh ,239,7

B. HEREDITY and varicose veins StudyMethodologyNb patientsOR TEMPERE(02) Population Questionnaire Multivariate analysis 70004,9 ESSEN (04) Cross sect. Questionnaire and examination Multivariate analysis 99355,2

B. HEREDITY and 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 Jawien et al. Phlebology 2004

C.Number of pregnancies ( P) and CVD 1 POR= 1,3 2 POR = 1,4 3 POR = 1,6 4 P OR = 1,9 >5 POR = 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 Asians San Diego Study Criqui Am J Epidemiol 2003

Visible disease and ethnicity in San Diego Study EthnicityNormalSpider veins Varicose veins Trophic changes Non Hispanic White 14,354,824,06,9 Hispanic18,950,026,34,7 African- american 27,745,320,86,3 Asian31,145,418,74,8

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

Clinical description of CVD using the CEAP classification

Risk factors

Treatment modalities

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 - congenital P - primary S - secondary S - superficial D - deep P - perforators R - reflux O - obliteration R,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