Association of varicose veins with incidence risk of atrial fibrillation: a population-based cohort study

Background:Varicose veins (VV) were once considered benign and common ailments; however, recent research suggests a potential link between VV and cardiovascular diseases or mortality. VV share common risk factors and pathophysiology with cardiovascular disease, potentially influencing the vascular system. Therefore, the authors aimed to investigate the association between VV and the incidence risk of atrial fibrillation (AF) using a population-based cohort. Methods:Our retrospective cohort study included 2 680 971 individuals who underwent examination through the Korean National Health Screening Service from 2010 to 2011. VV was defined by two or more claims with the International Classification of Diseases 10th Revision diagnostic codes: I83.0, I83.1, I83.2 (VV of lower extremities with ulcer or inflammation, severe VV), and I83.9 (asymptomatic VV of lower extremities, mild VV). The 1:3 propensity score matching (PSM) was used to assess the risk of newly developed AF, identified via insurance claims coded as I48. Results:The mean age of all participants was 48.5 +/- 14.2 years, with 51.4% being male. Among the population, 24 557 (0.91%) had VV, including 3684 (0.14%) of severe VV and 20 873 (0.77%) of mild VV. During a median follow-up of 10.06 years, 24 557 (0.92%) cases of AF occurred. Participants with VV exhibited an increased incidence risk of AF compared to those without it before (HR: 1.13, 95% CI: 1.06-1.21, P<0.001) and after PSM (HR: 1.17, 95% CI: 1.08-1.27, P<0.001). This positive association was consistently observed in severe VV both before (HR: 1.19, 95% CI [1.09-1.28], P=0.002) and after PSM (HR: 1.20, 95% CI [1.10-1.30], P=0.003) and mild VV also before (HR: 1.10, 95% CI [1.04-1.16], P=0.003) and after PSM (HR: 1.13, 95% CI [1.03-1.-20], P<0.001). Conclusions:These findings suggest that VV may be associated with an increased risk of AF. Hence, the presence of VV should be considered as an association factor for AF occurrence.