EPIDEMIOLOGY OF CHRONIC VENOUS INSUFFICIE NCY

From an epidemiological point of view, at least three different entiti es of chronic venous insufficiency (CVI) can be defined: heavy legs sy ndrome is experienced by about half the working people of industrializ ed countries. It is most frequently linked to varicosis, nevertheless, in one case out of three, no venous incompetence is associated. Femal e sex, prolonged standing position and overweight are other significan t risk factors; varicosis comes with modern civilization. Its prevalen ce is very low in African and Asian or Australasian aborigen populatio ns although immigrant subjects from these regions have the same risk a s the population of their host country. Sedentarity, overweight, tight clothing may provide part of the explanation. But the main factor is probably linked to the low fiber dite in industrialized countries thro ugh induced constipation and increased abdominal pressure, or because of the associated low vitamin F intake. Varicosis is rarely seen befor e adulthood, and its prevalence increases with aging. Sex ratio is unb alanced (F/M estimates: 1.5 to 3.5), that is mainly explained by child bearing and hormonal factors. A familial factor has also been evidence d, with a relative risk of 2, when one parent has varicosis, and about 3 when both are involved; epidemiological data regarding cutaneous tr ophic changes in CVI are restricted to leg ulcers; 1% of the general p opulation, and 4 to 5% of people aged 80 and more are afflicted. Leg u lcers are frequently found in the post-thrombotic syndrome, but female sex and varicosis are other significant risk factors. Up to now, epid emiological data are too scarce for a definite demonstration of the na tural history of the different subsets of CVI. On the other hand, they clearly show that major medical, social and economical problems are i nvolved.