Varicose veins risk factors

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Varicose veins are associated with multiple risk factors. The most important one is a family history of varicose veins. Other risk factors include increasing age, female sex, prolonged periods of standing, Pregnancy, Obesity. These risk factors can lead to the incompetence of venous valves.

Common risk factors

There are several risk factors for varicose veins[1]:

  • Age: With advancing age, the valves of the veins are exposed to wear and tear. This can lead to the development of the incompetence of the one-way valves[2] that regulate the venous blood flow. This leads to backward leaking of pressure from deep veins to the superficial veins. This leads to increased prevalence of varicose veins in the elderly.
  • Sex: It has been found that females are more prone to develop varicose veins. It has been hypothesized that estrogen plays are role in this. Estrogen caused increased relaxation of veins, limiting proper closure of the valves[3]. Varicose portions of veins often have higher density of estrogen receptors when compared with non-varicose portions of the veins[4]. Oral contraceptive pills may increase the chances of varicose veins.
  • Pregnancy: During pregnancy, several physiologic changes occur. These changes help make sure that the fetus gets proper nutrition and increase the chances of its survival. The expansion of intravascular blood volume is one of these changes. Previous pregnancies have been found to be an independent risk factor for varicose veins in women[5]. Hormonal changes of pregnancy also play a role in this predispostion.
  • Family history: Positive family history is present in a lot of cases varicose veins. The association seems to be more with prevalence rather than incidence[6]. In 2019, a genetic makeup study for varicose veins' patients revealed that most patients shared a host of abnormal genes that are responsible for angiogenesis[7]. This might help in development of new therapies targeting these genes.
  • Obesity: Obese patients have been to be associated with significantly higher CEAP clinical stages as compared to non-obese patients even in people with similar anatomical patterns of venous incompetence[8]. The obese patients were observed to have significantly more saphenofemoral reflux[9].
  • Prolonged standing: People in prolonged hours of standing tend to develop Varicose veins. Prolonged standing can raise the venous pressure in the legs.


  2. van Langevelde K, Srámek A, Rosendaal FR (2010). "The effect of aging on venous valves". Arterioscler Thromb Vasc Biol. 30 (10): 2075–80. doi:10.1161/ATVBAHA.110.209049. PMID 20671232.
  3. Raffetto JD, Qiao X, Beauregard KG, Khalil RA (2010). "Estrogen receptor-mediated enhancement of venous relaxation in female rat: implications in sex-related differences in varicose veins". J Vasc Surg. 51 (4): 972–81. doi:10.1016/j.jvs.2009.11.074. PMC 2847594. PMID 20347696.
  4. Mashiah A, Berman V, Thole HH, Rose SS, Pasik S, Schwarz H; et al. (1999). "Estrogen and progesterone receptors in normal and varicose saphenous veins". Cardiovasc Surg. 7 (3): 327–31. doi:10.1016/s0967-2109(98)00132-x. PMID 10386751.
  5. Krasiński Z, Sajdak S, Staniszewski R, Dzieciuchowicz L, Szpurek D, Krasińska B; et al. (2006). "[Pregnancy as a risk factor in development of varicose veins in women]". Ginekol Pol. 77 (6): 441–9. PMID 16964695.
  6. Ahti TM, Mäkivaara LA, Luukkaala T, Hakama M, Laurikka JO (2009). "Effect of family history on the incidence of varicose veins: a population-based follow-up study in Finland". Angiology. 60 (4): 487–91. doi:10.1177/0003319709335510. PMID 19625267.
  7. Shadrina AS, Sharapov SZ, Shashkova TI, Tsepilov YA (2019). "Varicose veins of lower extremities: Insights from the first large-scale genetic study". PLoS Genet. 15 (4): e1008110. doi:10.1371/journal.pgen.1008110. PMC 6490943. PMID 30998689.
  8. van Rij AM, De Alwis CS, Jiang P, Christie RA, Hill GB, Dutton SJ; et al. (2008). "Obesity and impaired venous function". Eur J Vasc Endovasc Surg. 35 (6): 739–44. doi:10.1016/j.ejvs.2008.01.006. PMID 18313335.
  9. Mahapatra S, Ramakrishna P, Gupta B, Anusha A, Para MA (2018). "Correlation of obesity & comorbid conditions with chronic venous insufficiency: Results of a single-centre study". Indian J Med Res. 147 (5): 471–476. doi:10.4103/ijmr.IJMR_1844_16. PMC 6094506. PMID 30082571.

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