by Eileen Masciale
Too many adults in this country are overweight. A study in the Journal of the American Medical Association on Prevalence and Trends in Obesity Among US Adults, 1999-2008, determined that the prevalence estimates for overweight and obesity combined (Body Mass Index/BMI >25) were 68 percent.
Americans know that being overweight is not healthy. In fact, on its website, the US Centers for Disease Control and Prevention lists consequences related to obesity:
• Coronary heart disease
• Type 2 diabetes
• Cancers (endometrial, breast, and colon)
• Hypertension (high blood pressure)
• Dyslipidemia (for example, high total cholesterol or high levels of triglycerides)
• Liver and Gallbladder disease
• Sleep apnea and respiratory problems
• Gynecological problems
What’s missing on this list is clear to venous diseasespecialists who know from their clinical experiencethe havoc that added weight can wreak on the veins.
“As morbid obesity becomes an epidemic, we need to document how it impacts chronic venous disease. Chronic venous disease can be an extremely debilitating condition and examining factors that contribute to it remains critical to treatment and prevention,” said Robert McLafferty, MD , Professor, Division of Vascular Surgery, Southern Illinois University School of Medicine, and President-Elect of the American Venous Forum.
Now, thanks to the American Venous Forum’s (AV F) National Venous Screening Program, the data on BMI and venous disease is in, confirming what many vein specialists have seen clinically. The results of the study, Venous Disease and the Effects of Increasing Body Mass Index: Results from the National Venous Screening Program, were presented at the AV F’s annual meeting earlier this year.
Lead investigator Colleen J. Moore, Assistant Professor in the Division of Vascular Surgery at the Southern Illinois University School of Medicine, and her colleagues looked at differences in venous disease across a spectrum of BMI from 7,227 participants in the AV F, National Venous Screening Program (NSVP) between 2005 and 2010, which represents one of the largest sample populations correlating obesity and venous disease.
The study found that manifestations of chronic vein insufficiency generally increase with higher BMI s, an observation previously suspected, but now supported by this study. “Among all the other issues of obese patients, doctors need to add venous problems as a consideration,” said Marc Passman, MD , Associate
Professor of Surgery, University of Alabama at Birmingham, and co-chair of the AV F, NSVP, who co-authored the study. “We hope that this study will raise awareness of venous disease among doctors treating obese patients so they can perform tests and prescribe treatments that can prevent serious venous complications.”
Specific Study Results
From overweight (BMI 25-29.9) to obese (BMI 30-24.9) to morbidly obese (BMI 35-39.9) to super morbidly obese (BMI >40), the risk of venous disease increase. Specifically, the study showed:
• The mean venous thromboembolism risk score increased from 3.5 for those who are overweight to over 4 for those who are super morbidly obese, thereby placing the morbidly obese patient into the highest risk category. (Fig. A)
• CEAP scores – which categorize venous disease based on the presentation in four areas: clinical, etiologic, anatomic and pathophysiologic -- showed increasing significant risk, especially for the morbidly obese and super morbidly obese. (Fig. B)
• The Venous Clinical Severity Score (VCSS) showed increased risk for all overweight categories, increasing for more severe obesity classes. (Fig. C)
• Venous obstruction correlates with BMI. (Fig. D)
• The Chronic Venous Insufficiency Quality of Life questionnaire – CIVIQ - which measure pain, impact on social activities and physical function -- showed a decreased quality of life for all overweight categories, increasing for more severe obesity classes. (Fig. E)
“The continuous pressure of the weight on the vein system may cause veins to fail over time and cause structural abnormalities,” explained Dr. Passman. “Primary careproviders need to pay more attention to these issues as the complications can be as dangerous and even fatal.”
National Venous Screening Program
The NSVP was established by the American Venous Forum in 2005 as part of a nationwide initiative to make vascular health a national health care priority. Its mission is to educate people about the venous thromboembolism (VTE ) risk, varicose veins and chronic venous insufficiency (CVI ). A venous specific questionnaire including a risk assessment tool, physical leg inspection, and screening noninvasive venous ultrasound are used to evaluate for venous disease. Upon completion of the screening, participants are provided an exit interview with venous directed educational material provided.
According to Dr. McLafferty, the NSVP is the only program in the country that offers a comprehensive screening to the public on a national scale. He explained, “It is an important vehicle for collecting data from a large population group and analyzing it for factors that may predispose to worsening disease.”
Free to the general public, the AV F, NSVP also encourages participants to inform their primary care provider and their family about the risk or presence of venous disease. JUZO , a leader in medical compression garments since 1912, was the founding sponsor of the NSVP and continues its support of this important health initiative. The NSVP is also supported by Sanofi Aventis.
“Venous disease is a serious disease that can lead to mortality. We feel that partnering with AV F National Screening Program compliments our JUZO education programs and is a good investment,” said Tom Musone, Director of Marketing, JUZO . “By helping to increase patients’ understanding of venous disease and prevention and, at the same time, helping medical professionals gain a better understanding of treatment options, it’s an all-around win.”