Varicose vein is associated with an increased risk of ischemic stroke: a population-based matched cohort study

IMPORTANCE: The association between varicose veins (VVs) and stroke, and the influence of VV management on the risk of stroke remained unclear. OBJECTIVE: To evaluate whether VVs are associated with an elevated risk of stroke and assess if interventions for VVs alter this risk. DESIGN: From 1 January 2000 to 31 December 2015, adults with VVs were matched by propensity score with those without VVs. Patients with prior strokes were excluded. Follow-up continued until 31 December 2018. OUTCOMES: Relative hazards through comparing incidence rates of ischemic stroke (IS) and hemorrhagic stroke (HS) between the two groups using Cox proportional hazards models. RESULTS: Comparison of the VV group (n = 23 238, mean [SD] age = 54.3 [15.6] years; 70% female) with the non-VV group (n = 92 952, mean [SD] age = 54.1 [15.7] years; 71% female) revealed a higher incidence rate of IS in the former than the latter (13.15 vs. 11.16 per 1000 person-years; 2555 vs. 8799 cases, respectively). The adjusted hazard ratio (aHR) for overall stroke in the VV group was 1.16 (95% CI = 1.11-1.21). Both females (aHR = 1.18 [95% CI = 1.11-1.25]) and males (aHR = 1.15 [95% CI = 1.07-1.24]) with VVs showed an increased IS risk. In patients aged ≥50, VVs were associated with a higher IS risk (aHR = 1.17 [95% CI = 1.12-1.23]). No significant correlation was found between VVs and HS. The association of VV management with a reduced risk of stroke (aHR = 0.82 [95% CI = 0.70-0.96]) was supported by sensitivity analyses. CONCLUSIONS: Adults with VVs showed an increased risk of IS but not HS. Key message What is already known on this topic. Varicose veins (VVs) are linked to cardiovascular conditions, but their association with stroke risk and the impact of VV interventions remain unclear. What this study adds. This study demonstrated that adults with VVs, especially those aged ≥50, have a higher ischemic stroke (IS) risk. VV interventions may reduce this risk. How this study might affect research, practice, or policy. Stroke risk assessment and VV management should be considered in older patients to improve preventive care.