Gender and racial disparities in vascular complications associated with varicose veins: a retrospective cohort study

The association between varicose veins and the development of pulmonary embolism (PE), peripheral arterial disease (PAD), and deep vein thrombosis (DVT) remains a subject of clinical interest and ongoing investigation. The objective of this study was to confirm the relationship between varicose veins and the later development of vascular complications. We conducted a retrospective cohort analysis using healthcare data from the TriNetX analytics platform, using propensity score matching (PSM) with a 1:1 ratio to control for potential confounding factors. After PSM, the analysis included 297,629 patients in both the varicose vein and control groups, with each group comprising 197,143 females and 92,725 males. Patients with varicose veins showed increased risks for PE (hazard ratio [HR]: 1.17; 95% confidence interval [CI]: 1.13–1.21), PAD (HR: 1.53; 95% CI: 1.48–1.58), and DVT (HR: 2.48; 95% CI]: 2.38–2.59). Gender differences emerged in PE risk: males showed increased risk (HR: 1.53; 95% CI: 1.45–1.62) while females did not (HR: 0.97; 95% CI: 0.93–1.02). This pattern held for White and Black populations, but not for Asians, where neither gender showed increased PE risk. For PAD, males consistently showed higher risk (HR: 1.91; 95% CI: 1.82–2.00) than females (HR: 1.34; 95% CI: 1.29–1.40) across all ethnic groups. The gender pattern of DVT risk across ethnic groups was similar to that observed for PAD. This research demonstrates that males with varicose veins, across all ethnic groups, are at a particularly elevated risk of vascular complications.