The legs are a pathway to the heart: connections between chronic venous insufficiency and cardiovascular disease

This editorial refers to ‘Chronic venous insufficiency, cardiovascular disease, and mortality: a population study’, by J.H. Prochaska et al., https://doi.org/10.1093/eurheartj/ehab495. During evaluation of varicose veins, my patients frequently ask me whether the ‘bad circulation’ in the legs indicates that they are going to develop heart disease. My typical answer is reassuring, explaining that the veins in the leg are different from the arteries in the heart that cause heart attacks. I encourage heart-healthy walking and diet but not additional concern about cardiovascular risk. The manuscript by Prochaska and colleagues in this issue of the European Heart Journal challenges our conventional thinking about the separation of venous and arterial disease and has important clinical implications.1 Chronic venous disease has a high global prevalence, with diverse manifestations ranging from telangiectasia to varicose veins and, in advanced cases, ulcerations.2 The underlying pathophysiology involves venous hypertension in the legs induced...