The Incidence and Progression of Peripheral Venous Disease

描述（由申请人提供）：静脉疾病很常见，是发病和偶尔死亡的主要原因，占所有心血管疾病支出的30%。静脉疾病的定义往往混淆了症状和体征的病理生理异常。在我们之前的静脉患病率研究中，使用分层类别，我们在多种族人群中准确地确定了可见疾病的存在或不存在以及一致程度-正常（NL）、静脉曲张（W）、营养变化（TCS）和功能性疾病（反流或阻塞）通过双功能超声-正常、浅层功能性疾病（SFD）、深层功能性疾病（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、症状和生活质量的相关性。到目前为止，还没有严格的评估静脉疾病的发病率在一个确定的人群。具体目标是：首先，确定1200名男性和女性（2400条腿）中10年新发静脉疾病的发病率，以及现有静脉疾病的进展，这些患者来自我们的研究人群，基线时已知静脉疾病状态。偶发疾病定义为从视觉和功能正常转变为W、TCS、SFD或DFD。疾病进展将定义为从W转变为TCS或从SFD转变为DFD，或在这些类别内进展。我们将分别确定静脉血栓形成和肺栓塞的发生率。第二，评价偶发/进行性静脉疾病的风险因素，重点关注患病率研究中可能因“反向因果关系”而产生偏倚的风险因素;即，静脉疾病可能引起而不是，或者也是由风险因素引起的;例如，体力活动、肥胖和药物使用，以及选择的储存的血浆标记物，重点是血栓形成和炎症因子。这些数据可能会影响预防战略。第三，确定症状与静脉疾病的时间关系;即，症状可以先于（以及跟随）事件/进行性疾病吗？这些数据可能对静脉疾病的临床诊断有重要意义。第四，评价SF-36的变化，SF-36是一种生活质量指数，伴随偶发/进展性静脉疾病，控制非静脉发病率，以提供偶发和进展性静脉疾病负担的定量估计。该应用程序建立在我们的患病率研究的开创性发现基础上，由于没有此类发病率数据，因此具有原创性和创新性。

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.