As the severity of chronic venous disease increases (Mvc), a pathology that affects the circulation that reaches the heart from the periphery, an increased cardiovascular risk is associatedas well as all-cause mortality. They are the results of studio Gutenbergrecently published in the European Heart Journal, which investigated, for the first time, in a general population, the prevalence of chronic venous insufficiency – advanced stage of CVD – and the association between this and cardiovascular comorbidities.
“The scientific evidence that has emerged – he explains Romeo Martini, president of the Italian Society of Angiology and Vascular Pathology (Siapav) – challenge conventional thinking about the separation of venous and arterial disease. Observation of the legs is essential to diagnose CVD but the presence of varicose veins, oedema, skin changes and ulcers should be considered a potential warning sign of cardiovascular disease”. Often trivialized and limited to a simple aesthetic disorder of the legs, it is one of the most widespread diseases in the West – explains Servier in a note – In our country it affects about 19 million people, from 10% to 50% of men and over half of women. It is a venous pathology characterized by an impaired return of blood from the periphery to the heart, a complex, chronic and worsening condition, which tends to progress rapidly towards more advanced stages if not treated correctly.
“Under normal conditions – he says Alberto Froio, Associate Professor of Vascular Surgery, University of Milan-Bicocca Irccs-San Gerardo dei Tintori Foundation, Monza – 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 impaired, blood flows back through the valve leaflets causing vein dilation supported by a chronic inflammatory process. In its most severe forms, CVD can cause serious complications such as edema, skin pigmentation, eczema up to the appearance of ulcers and venous thrombosis”.
“Even today – observes Martini – the patient with CVD is started on a diagnostic-therapeutic path (Pdta) limited to the pathology of the lower limbs only. It would be time for them to define themselves Pdta taking into account the suggestions of the Gutenberg study, i.e., provide additional and simple vascular screening for patients with CVD in the most advanced stages. A family history of cardiovascular disease, palpation of the arterial pulses, measurement of the ankle/brachial pressure index and LDL cholesterol dosage can easily be performed on the patient with CVD, highlighting those at higher cardiovascular risk”.
After all, “the two pathologies – he adds Leonardo De Luca, general secretary of hospital cardiologists (Anmco) and cardiologist at the San Camillo-Forlanini hospital in Rome – share some risk factors such as age, smoking, diabetes mellitus, obesity and being overweightwhich are associated with a dysfunction of the endothelium, a chronic inflammation and a thrombosis which is due to the slow flow and the consequent hypercoagulability which constitute the pathophysiological bases of both pathologies” .
In line with the results of the Gutenberg study, “a hypothesis that is gaining ground in the scientific community – recalls Roberto Pola, Siapav secretary – assumes that chronic inflammation is the biological mechanism underlying these two pathologies. In fact, in atherosclerotic pathology, which is the basis of heart attack and stroke, there is an important inflammatory contribution and, on the other hand, an increased production of inflammatory molecules is also observed in chronic venous disease”.