Is chronic venous disease a marker of systemic cardiovascular risk? A systematic review.

Introduction: To evaluate whether chronic venous disease (CVeD) is associated with incident hard cardiovascular outcomes in longitudinal cohort studies and whether cardiovascular risk increases with greater venous disease severity. Methods: We conducted a systematic review with exploratory meta-analysis where appropriate. Prospective or retrospective cohort studies enrolling adults with CVeD or proxy venous phenotypes defined at baseline and reporting incident cardiovascular outcomes using multivariable-adjusted time-to-event estimates were included. Prespecified outcomes were myocardial infarction or acute coronary syndrome, ischemic stroke, heart failure, cardiovascular mortality, and all-cause mortality. Results: Five eligible cohort studies were identified. In a Taiwanese nationwide matched cohort, advanced varicose veins were associated with increased risks of heart failure, acute coronary syndrome, ischemic stroke, and all-cause mortality. A South Korean nationwide cohort reported increased incident heart failure among patients with varicose seveins, while a population-based matched cohort demonstrated an increased risk of ischemic stroke. In an Australian cohort severe CVeD was associated with increased major adverse cardiovascular events compared with mild disease, suggesting a severity gradient. Exploratory pooled analyses indicated increased risks of heart failure and ischemic stroke, although heterogeneity across studies was substantial. Mortality estimates were directionally consistent but were interpreted narratively because exposure definitions and severity contrasts differed between studies. Conclusions: Available longitudinal evidence suggests that CVeD is associated with increased risk of subsequent cardiovascular events and all-cause mortality. A consistent severity gradient was observed, with more advanced venous disease associated with greater cardiovascular risk.