title: High endogenous estradiol is associated with increased venous distensibility and clinical evidence of varicose veins in menopausal women.
abstract: OBJECTIVE
  The purpose of this study was to determine if there is an association between elevated sex hormones (ie, serum estradiol, sex hormone binding globulin [SHBG], testosterone) and increased venous distension and clinical evidence of varicose veins in menopausal women.
  
  
  METHODS
  Participants were 104 healthy volunteer menopausal women, aged 48 to 65 years, who were not undergoing hormonal treatment. Of these 104, 14 were excluded from analyses because their estradiol levels were compatible with a premenopausal condition (4), because they had missing values for insulin concentration (5), and because they did not show up at venous vessel examination (5). Patients underwent a physical examination to determine the presence of varicose veins; a venous strain-gauge plethysmographic examination to compute instrumental measures of venous distensibility; and laboratory analyses of blood so serum testosterone, estradiol, SHBG, glucose, and insulin could be measured. There were also prevalence ratios and odds ratios used to test the presence of an association between biochemical and instrumental variables.
  
  
  RESULTS
  Serum levels of estradiol in the upper tertile of the frequency distribution were significantly associated with clinical evidence of varicose veins (prevalence odds ratios 3.6; 95% CI 1.1-11.6) and with increased lower limb venous distensibility (prevalence odds ratios 4.4; 95% CI 1.2-15.5). No association was found for SHBG and testosterone.
  
  
  CONCLUSIONS
  Our finding that high serum levels of estradiol are associated with clinical evidence of varicose veins and instrumental measurements indicating increased venous distensibility in menopausal women suggests that endogenous estrogens may play a role in the development of this very common venous vessel abnormalities.
authors.affiliation: CeVeas, Azienda USL, Modena, Italy.
authors.forename: A V
authors.initials: AV
authors.lastname: Ciardullo
authors.forename: S
authors.initials: S
authors.lastname: Panico
authors.forename: C
authors.initials: C
authors.lastname: Bellati
authors.forename: P
authors.initials: P
authors.lastname: Rubba
authors.forename: S
authors.initials: S
authors.lastname: Rinaldi
authors.forename: A
authors.initials: A
authors.lastname: Iannuzzi
authors.forename: V
authors.initials: V
authors.lastname: Cioffi
authors.forename: G
authors.initials: G
authors.lastname: Iannuzzo
authors.forename: F
authors.initials: F
authors.lastname: Berrino
mesh_terms: D000368:Aged; D002979:Climacteric / Q000502:physiology*; D004958:Estradiol / Q000097:blood*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012016:Reference Values; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism; D013739:Testosterone / Q000097:blood; D014648:Varicose Veins / Q000503:physiopathology*; D014655:Vascular Resistance / Q000502:physiology*
chemical_list: D012738:Sex Hormone-Binding Globulin; D013739:Testosterone; D004958:Estradiol