Varicose veins and heredity

Varicose Veins and Heredity: Is Your Family to Blame?

Many patients with varicose veins say that "it runs in the family" - and research backs them up. Genetics is one of the strongest single risk factors for varices (varicose veins), and if both parents have varicose veins, their children have up to a 90% lifetime risk of developing them too [1].

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How Significant Is the Hereditary Component?

Twin studies and large cohort studies have shown that:

• Heredity accounts for 40-60% of the risk for varicose veins [2]
• If one parent has varicose veins, the risk is approx. 25-40%
• If both parents have varicose veins, the risk increases to ~90% [1]
• If neither parent has varicose veins, the risk is approx. 20%

A recent large-scale genomic study (UK Biobank, 493,000 participants) identified 30+ genetic loci associated with varicose veins - many of them related to the collagen and elastin in the vein wall, valve function, and venous development [3].

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Which Genes Are Involved?

Researchers have demonstrated a link with:

• CASZ1 - a transcription factor in venous development
• PIEZO1 - a mechanosensory ion channel in the vessel wall
• FOXC2 - known from hereditary venous diseases
• HFE and haemochromatosis genes
• MTHFR - related to homocysteine and venous thrombosis

These genes affect the strength of the vein wall, the function of the valve system, and the composition of the connective tissue [3,4].

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Heredity vs. Environment

Genetics determine your vulnerability - but not whether you will actually develop varicose veins. Modifiable risk factors play a major role:

• Sedentary or standing work
• Being overweight
• Pregnancies (see varicose veins during pregnancy)
• Lack of exercise
• Smoking
• Age (the incidence increases by 2-3% annually after the age of 40)

Even in individuals with a strong familial predisposition, lifestyle can significantly delay the onset and worsening of the condition [5].

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Should You Be Screened if It Runs in Your Family?

Routine screening is not recommended, but it is sensible to be aware of early symptoms:

• Heavy, tired legs at the end of the day
• Swelling around the ankles
• Night cramps
• Visible, winding veins on the thigh or calf
• Spider veins (telangiectasias) - often the first clinical sign
• Itching, brownish discolouration or eczema in the ankle area

If symptoms are present, a Doppler ultrasound of the leg veins is performed. This is a painless examination that maps the valve function and reflux in each individual vein. It is the gold standard for investigating chronic venous insufficiency [6].

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Prevention if It Runs in the Family

• Exercise: 30 minutes daily - walking, cycling, and swimming activate the "muscle pump" in the calf
• Weight management: Every extra kilo increases the pressure in the leg veins
• Avoid prolonged static positions: Alternate between standing and sitting; do heel raises at your workplace
• Elevate your legs above heart level for 15-20 minutes daily
• Wear graduated compression stockings for standing work or long-haul flights [7]
• Stop smoking - nicotine weakens the vessel wall
• Take the first symptoms seriously - early treatment prevents skin complications such as ulceration

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If You Do Develop Varicose Veins

Modern endovenous laser treatment (EVLT) has replaced classic vein stripping as the standard treatment and offers:

• A 95% closure rate after 5 years [8]
• Treatment under local anaesthetic, with patients going home the same day
• A quick return to work (1-3 days)
• Significantly fewer complications than traditional surgery [9]

At our clinic, we offer investigation with Doppler ultrasound and endovenous laser treatment through the public healthcare system. You can also read our article on varices.

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References

1. Cornu-Thénard A, et al. Importance of the familial factor in varicose disease. J Dermatol Surg Oncol 1994;20(5):318-26.
2. Brinsuk M, et al. Heritability of venous function. Arterioscler Thromb Vasc Biol 2004;24(1):207-10.
3. Fukaya E, et al. Clinical and genetic determinants of varicose veins: prospective, community-based study of ~500,000 individuals. Circulation 2018;138(25):2869-80.
4. Krysa J, Jones GT, van Rij AM. Evidence for a genetic role in varicose veins and chronic venous insufficiency. Phlebology 2012;27(7):329-35.
5. Beebe-Dimmer JL, et al. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol 2005;15(3):175-84.
6. Gloviczki P, et al. The 2022 SVS/AVF/AVLS clinical practice guidelines for the management of varicose veins. J Vasc Surg Venous Lymphat Disord 2023;11(2):231-61.
7. Lim CS, Davies AH. Graduated compression stockings. CMAJ 2014;186(10):E391-8.
8. Rasmussen LH, et al. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg 2011;98(8):1079-87.
9. Hamann SAS, et al. Five-year results of great saphenous vein treatment: a meta-analysis. Eur J Vasc Endovasc Surg 2017;54(6):760-70.