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Fowkes F. G. R.
Wolfson Unit for Prevention of Peripheral Vascular Diseases, Public Health Sciences, University of Edinburgh, Edinburgh, UK
Chronic venous insufficiency in the legs can range from minor asymptomatic incompetence of venous valves to disabling chronic leg ulceration. Most epidemiological studies have not covered the complete spectrum of disease but have been restricted to one aspect, and this has usually been either varicose veins or leg ulceration. The prevalence of varicose veins is around 25%-33% in women in western countries. A lower prevalence of around 10%-20% has been found in men but recent studies suggest that prevalence in men may be increasing. The prevalence of varicose veins increases with age in both sexes and may be less common in most developing countries. Skin changes occur frequently in those with varicose veins and are more common the more severe the varicosities. Open venous ulcers occur in roughly 0.3% of the adult population and the prevalence of open or healed ulceration is about 1.0%. The evidence relating risk factors to the presence of venous insufficiency is inconclusive. Obesity, especially in women, and previous pregnancy are the most consistent risk factors. The evidence linking lifestyle factors, such as fibre depleted diet or standing at work, to the occurrence of venous insufficiency is not strong. Genetic inheritance has not been demonstrated, but much further research is required on this and other aetiological factors for venous disease.