The Incidence and Progression of Peripheral Venous Disease

描述（由申请人提供）：静脉疾病是常见的，是发病率和偶尔死亡的主要原因，占所有心血管疾病支出的30%。静脉疾病的定义常常混淆症状和体征与病理生理异常。在我们之前的静脉患病率研究中，我们使用分层分类，在多民族人群中准确地建立了可见疾病-正常（NL），静脉曲张(W)，营养变化（TCS）和功能疾病（反流或梗阻）的存在或不存在以及一致性程度-双工超声-正常，浅表功能疾病（SFD），深层功能疾病（DFD）。我们记录了下肢特异性评估的重要性，并报告了年龄、性别和种族的患病率，以及静脉疾病与危险因素、症状和生活质量的关系。迄今为止，还没有对特定人群中静脉疾病发生率的严格评估。具体目的是：首先，确定在基线时已知静脉疾病状态的1200名男性和女性（2400条腿）中，新静脉疾病的10年发病率和现有静脉疾病的进展情况。偶发性疾病将被定义为从外观和功能正常到W， TCS， SFD或DFD的转变。进行性疾病将被定义为从W到TCS或从SFD到DFD的过渡，或在这些类别中的进展。我们将分别确定静脉血栓和肺栓塞的发生率。其次，评估突发/进展性静脉疾病的危险因素，重点关注流行病学研究中可能存在“反向因果关系”偏差的危险因素；即，静脉疾病可能导致而不是风险因素，或者也是风险因素的结果；例如，身体活动，肥胖和药物使用，以及选择储存的血浆标志物，重点是血栓和炎症因子。这些数据可能会影响预防策略。第三，确定症状与静脉疾病的时间关系；即，症状是否可以先于（也可以先于）偶发/进行性疾病？这些数据对静脉疾病的临床诊断具有重要意义。第四，评估SF-36（一种生活质量指数）在发生/进展性静脉疾病时的变化，控制非静脉疾病的发病率，为发生性和进展性静脉疾病的负担提供定量估计。这个应用程序建立在我们的流行病学研究的开创性发现的基础上，因为没有这样的发病率数据存在，是原创的和创新的。

DESCRIPTION (provided by applicant): Venous disease is common, a major cause of morbidity and occasionally mortality, and accounts for 30% of all cardiovascular disease expenditures. Venous disease definitions have often confused symptoms and signs with pathophysiologic abnormalities. In our previous venous prevalence study, using hierarchical categories, we accurately established in a multi-ethnic population the presence or absence, and degree of concordance, of visible disease -normal (NL), varicose veins (W), trophic changes (TCS), and functional disease (reflux or obstruction) by Duplex ultrasound -normal, superficial functional disease (SFD), deep functional disease (DFD). We documented the importance of leg-specific assessment, and reported prevalence by age, sex, and ethnicity, and the association of venous disease with risk factors, symptoms, and quality of life. To date, there has been no rigorous assessment of the incidence of venous disease in a defined population. The specific aims are: First, to determine the ten-year incidence of new venous disease, and progression of existing venous disease, in 1200 men and women (2400 legs) from our study population with known venous disease status at baseline. Incident disease will be defined as transition from visibly and functionally normal to W, TCS, SFD, or DFD. Progressive disease will be defined as a transition from W to TCS or from SFD to DFD, or progression within these categories. We will separately determine the incidence of venous thrombosis and pulmonary embolism. Second, to evaluate risk factors for incident/progressive venous disease, focusing on risk factors potentially biased by "reverse causality" in prevalence studies; i.e., venous disease may cause rather than, or as well as, result from the risk factor; e.g., physical activity, obesity, and medication use, and selected stored plasma markers with a focus on thrombotic and inflammatory factors. Such data could impact prevention strategies. Third, to determine the temporal relation of symptoms with venous disease; i.e., can symptoms precede (as well as follow) incident/progressive disease? Such data could be important in clinical diagnosis of venous disease. Fourth, to evaluate change in the SF-36, a quality of life index, with incident/progressive venous disease, controlled for non-venous morbidity, to provide quantitative estimates of the burden of incident and progressive venous disease. This application builds on the seminal findings in our prevalence study, and since no such incidence data exist, is original and innovative.