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Fatores de risco para a severidade da doença varicosa dos membros inferiores em pacientes cirúrgicos situados abaixo da linha de pobreza, Vitória da Conquista, Brasil
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Contexto: A doença venosa crônica apresenta alta prevalência na população abaixo da linha da pobreza (ALP) com elevado custo social, mas poucos estudos avaliaram os fatores de risco nesta população.
Objetivo: Identificar fatores associados a maior gravidade da doença na população ALP.
Métodos: Realizado estudo retrospectivo de 110 pacientes ALP submetidos ao tratamento cirúrgico de varizes dos membros inferiores. O grupo controle (GC) foi constituído por 30 pacientes acima da linha da pobreza operados no mesmo período. Para avaliação da severidade foram utilizadas a classificação CEAP e o Venous Clinical Severity Score (VCSS). Para análise estatística utilizados o teste T Mann-Whitney, o Chi-quadrado, a análise de variância e o modelo de regressão linear.
Resultados: A média de idade ± erro padrão (EP) dos pacientes ALP foi 46.9 ±1.8anos, enquanto no GC 53.3 ±2.7anos (p=0.0496). Observada piora progressiva do VCSS com o aumento da idade nos pacientes ALP (r2=0.21, p=0.0007). Pacientes ALP apresentaram doença mais avançada (VCSS 7.3 ± 0.7 versus 4.4 ± 0.3, p=0.0017). Dentre pacientes ALP 84.5% do género feminino, 40.9% com sobrepeso, 16.4% obesos, 64.5% sedentários, percentuais não significativamente diferentes do GC. A média de gestações por mulher ALP foi superior ao GC (5.0 ± 0.5 versus 3.1 ±0.4, p=0.039), sendo 55.3% das pacientes ALP relataram ≥5 gestações comparado a 16.7% do GC (p=0.0073). Pacientes ALP apresentaram piora progressiva do VCSS com o aumento no número de gestações (r2=0.16, p=0.007). O percentual de mulheres que usou contraceptivo foi menor no grupo ALP comparado ao GC (51% versus 76%, p=0.0384) e as pacientes ALP que usaram contraceptivos tiveram menor número de gestações (3.7 ± 0.5 versus 6.1 ± 0.8, p=0.0433) e menor severidade da doença (VCSS 5.8 ±0.8 versus 9.4 ±1.2, p=0.0355) quando comparadas à pacientes ALP que não utilizaram. O percentual de pacientes ALP que relataram ortostase prolongada foi significativamente superior ao GC (66.4% versus 33.3%, p=0.006). Dentre os pacientes ALP aqueles que não permaneciam em ortostase prolongada e os que realizavam caminhadas semanais regulares apresentaram menor severidade da doença (p=0.0097 e p=0.0429 respectivamente). Observada piora do VCSS quanto maior o índice de massa corporal (IMC) dos pacientes ALP (r2=0.16, p=0.0133).
Conclusões: Nossos dados sugerem que as varizes dos membros inferiores apresentam-se mais precocemente e com maior severidade nos pacientes ALP, sendo que a ortostase prolongada, o número de gestações e o menor uso de contraceptivos podem estar relacionados a este achado. A severidade da doença nos pacientes ALP aumenta quanto maior a idade, o IMC e o número de gestações. Fatores relacionados a uma menor severidade da doença neste grupo foram a não permanência em ortostase prolongada, a realização de caminhadas regulares e o uso de contraceptivos, sendo possível que o efeito dos contraceptivos esteja relacionado à redução do número de gestações.
Background: Chronic superficial venous disease has a high prevalence in the population below the poverty line with a high social cost, but few studies have evaluated the risk factors in this population. Objective: To identify risk factors associated with the severity of varicose veins in below the poverty line patients (BPLP). Methods: We conducted a retrospective study of 110 BPLP submitted consecutively to surgical treatment of varicose veins of the lower limbs. The control group (CG) consisted of 30 patients above the poverty line operated in the same period. The severity was assessed with the CEAP classification and the Venous Clinical Severity Score (VCSS). For statistical analysis, the Mann-Whitney T test, the Chi-square test, the analysis of variance and the linear regression model were used. Results: The mean age ± standard error (SE) of the BPLP was 46.9 ± 1.8 years, and 53.3 ± 2.7 years in CG (p=0.0496). Progressive worsening of VCSS was observed with increasing age in BPLP (r2 = 0.21, p=0.0007). BPLP presented more advanced disease (VCSS 7.3 ± 0.7 versus 4.4 ± 0.3, p=0.0017). Among the BPLP, 84.5% were female, 40.9% were overweight, 16.4% were obese, 64.5% were sedentary, and these percentages were not significantly different from the CG. The mean number of pregnancies per woman in BPLP group was higher than the CG (5.0 ± 0.5 versus 3.1 ± 0.4, p=0.039), and 55.3% of the BPLP reported ≥5 pregnancies compared to 16.7% of the CG (p=0.0073). An increasing number of pregnancies lead to a progressive worsening of VCSS in BPLP (r2 = 0.16, p=0.007). The percentage of women who used contraceptives was lower in the BPLP group compared to the CG (51% versus 76%, p p=0.0384) and the BPLP who used contraceptives had a lower number of pregnancies (3.7 ± 0.5 versus 6.1 ± 0.8, p=0.0433) and lower disease severity (VCSS 5.8 ± 0.8 versus 9.4 ± 1.2, p=0.0355) when compared to BPLP who did not. The percentage of BPLP who reported prolonged orthostasis was significantly higher than the CG (66.4% versus 33.3%, p=0.006). Among the BPLP, those who did not remained in prolonged standing, and those who did regular weekly hiking had a lower disease severity (p=0.0097 and p=0.0429 respectively). The higher the body mass index (BMI) of the BPLP, the worst the VCSS (r2 = 0.16, p=0.0133). Conclusions: Our data suggest that lower limb varicose veins present earlier and more severely in BPLP, and that prolonged orthostasis, the number of pregnancies and a reduced use of contraceptives may be related to this finding. BPLP have a higher severity the higher age, BMI and the number of pregnancies. Factors related to a lower severity of the disease in this group were non-permanence in prolonged orthostasis, regular walking and contraceptive use, and it is possible that the effect of contraceptives is related to the reduction in the number of pregnancies.
Background: Chronic superficial venous disease has a high prevalence in the population below the poverty line with a high social cost, but few studies have evaluated the risk factors in this population. Objective: To identify risk factors associated with the severity of varicose veins in below the poverty line patients (BPLP). Methods: We conducted a retrospective study of 110 BPLP submitted consecutively to surgical treatment of varicose veins of the lower limbs. The control group (CG) consisted of 30 patients above the poverty line operated in the same period. The severity was assessed with the CEAP classification and the Venous Clinical Severity Score (VCSS). For statistical analysis, the Mann-Whitney T test, the Chi-square test, the analysis of variance and the linear regression model were used. Results: The mean age ± standard error (SE) of the BPLP was 46.9 ± 1.8 years, and 53.3 ± 2.7 years in CG (p=0.0496). Progressive worsening of VCSS was observed with increasing age in BPLP (r2 = 0.21, p=0.0007). BPLP presented more advanced disease (VCSS 7.3 ± 0.7 versus 4.4 ± 0.3, p=0.0017). Among the BPLP, 84.5% were female, 40.9% were overweight, 16.4% were obese, 64.5% were sedentary, and these percentages were not significantly different from the CG. The mean number of pregnancies per woman in BPLP group was higher than the CG (5.0 ± 0.5 versus 3.1 ± 0.4, p=0.039), and 55.3% of the BPLP reported ≥5 pregnancies compared to 16.7% of the CG (p=0.0073). An increasing number of pregnancies lead to a progressive worsening of VCSS in BPLP (r2 = 0.16, p=0.007). The percentage of women who used contraceptives was lower in the BPLP group compared to the CG (51% versus 76%, p p=0.0384) and the BPLP who used contraceptives had a lower number of pregnancies (3.7 ± 0.5 versus 6.1 ± 0.8, p=0.0433) and lower disease severity (VCSS 5.8 ± 0.8 versus 9.4 ± 1.2, p=0.0355) when compared to BPLP who did not. The percentage of BPLP who reported prolonged orthostasis was significantly higher than the CG (66.4% versus 33.3%, p=0.006). Among the BPLP, those who did not remained in prolonged standing, and those who did regular weekly hiking had a lower disease severity (p=0.0097 and p=0.0429 respectively). The higher the body mass index (BMI) of the BPLP, the worst the VCSS (r2 = 0.16, p=0.0133). Conclusions: Our data suggest that lower limb varicose veins present earlier and more severely in BPLP, and that prolonged orthostasis, the number of pregnancies and a reduced use of contraceptives may be related to this finding. BPLP have a higher severity the higher age, BMI and the number of pregnancies. Factors related to a lower severity of the disease in this group were non-permanence in prolonged orthostasis, regular walking and contraceptive use, and it is possible that the effect of contraceptives is related to the reduction in the number of pregnancies.
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Saúde tropical Doenças tropicais Varizes Anticoncepção Gravidez Obesidade Pobreza Vitória da Conquista Brasil