The chronic venous disease favorite smoking, overweight, standing for a long time without moving, too high heels and familiarity
Swollen ankles, red and purplish capillaries running down the legs, visible veins are often considered a cosmetic issue, but in reality they can be signs of chronic venous disease. In Italy, it affects over 19 million people, mostly women. And precisely because only one in three people are underestimated, she knows she is affected by it and follows correct therapy and an adequate lifestyle. Smoking, overweight, standing without moving for a long time, too high heels and familiarity are the main risk factors besides you
The cause
When the first signs appear, they should never be overlooked. To cause chronic venous disease a valve deficit that causes blood to flow from top to bottom, exactly the opposite of what normally happens, and this causes an increase in pressure in the capillaries, resulting in the formation of edema. The blood stagnates in the veins, the pressure increases and the veins tend to dilate. This causes ainflammation of the veinsappear pain, heaviness or an annoying one feeling bloated and over time the legs become darker and the skin tends to cut.
Cardiovascular risk
If left untreated it tends to progress towards much more serious stages, today, thanks to a recently published study (Gutenberg), there is evidence demonstrating that associated with a increased cardiovascular risk and also to an increase in mortality from all causes including cancer. The movement of blood from the lower limbs towards the heart takes place thanks to the pressure exerted by the muscles of the legs and by the plantar arch, with a unidirectional flow ensured by the venous valves. When this process is altered, the blood flows back through the valve flaps causing dilation of the veins supported by a chronic inflammatory process – explains Alberto Froio, Associate Professor of Vascular Surgery, University of Milan-Bicocca Irccs Foundation – San Gerardo dei Tintori, Monza – In its most severe forms, MVC can cause serious complications such as oedema, skin pigmentation, eczema up to the appearance of ulcers and venous thrombosis. The data from the Gutenberg study, which investigated the prevalence of chronic venous insufficiency, advanced stage of MVC, and the association between this and the comorbidity of cardiovascular pathologies in over 12,000 German patients between the ages of 40 and 80, demonstrating that an aggravation of the disease associated with an increased cardiovascular risk.
Investigations
The fundamental observation of the legs, the presence of varicose veins, edema, skin changes and ulcers must be considered a potential alarm bell of cardiovascular disease – underlines Romeo Martini, President of the Italian Society of Angiology and Vascular Pathology – Even today, in fact , the patient is started on a diagnostic-therapeutic path limited to lower limb pathology only. PDTAs should be redefined taking into consideration the suggestions of the Gutenberg study: provide additional and simple vascular screenings for patients with MVC in the more advanced stages and also a history of family history of cardiovascular disease. These patients, in fact, can undergo important cardiovascular complications, which confirm the link between the two pathologies. The link between MVC and cardiovascular disease is mainly due to the fact that they share some risk factors such as age, smoking, diabetes and being overweight, which are associated with a endothelial dysfunction, a chronic inflammation and a thrombosis which is due to the slow flow and the consequent hypercoagulability which constitute the pathophysiological basis of both pathologies – adds Leonardo De Luca, ANMCO Secretary General and cardiologist at the UOC of Cardiology of the San Camillo Hospital – Forlanini From Rome. For the first time the Gutenberg study demonstrates that chronic venous insufficiency o Chronic venous disease is actually a marker of cardiovascular disease such as heart attack and stroke. The Gutenberg study has shown that people with MVC in the most advanced stages have a higher risk of developing arterial cardiovascular disease over the years and also have a higher mortality from all causes, compared to people who do not suffer from it – Roberto points out Pola, Secretary of the Italian Society of Angiology and Vascular Pathology — A hypothesis that is making headway in the scientific community assumes that chronic inflammation is the biological mechanism underlying these two pathologies. Indeed, in atherosclerotic pathology, which is the basis of infarction and stroke, there is an important inflammatory contribution and, on the other hand, an increased production of inflammatory molecules is observed also in chronic venous disease.
Change of perspective
It is necessary to change the approach to the disease, particularly in the advanced stages, and also in clinical practice by specialists, especially in the diagnosis phase. A holistic vision of the patient, i.e. taking charge of all his problems and considering the possibility that there are distant interactions between pathologies that are apparently unrelated to each other – concludes Claudio Borghi, Director of the Cardiovascular Internal Medicine Department of Medical and Surgical Sciences-University of Bologna – In the last 20 years, in the field of cardiovascular diseases, this approach has also brought out other conditions, apparently detached from the functioning of the cardiovascular system, which are instead capable of conditioning the development of cardiovascular diseases and make the approach can no longer be focused only on a prevailing risk factor, but must evaluate each individual patient as a whole. A multidisciplinary approach by all specialists in order to define diagnostic-therapeutic paths able to better manage the patient.
March 12, 2023 (change March 12, 2023 | 10:24 am)
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