Abstract 3166

Background:

Chronic venous insufficiency (CVI) represents a spectrum of disease characterized by impaired venous return. Deep venous thrombosis (DVT) when complicated by post thrombotic syndrome (PTS) is a well established etiology for CVI. P-selectin is a cell adhesion molecule involved in thrombus formation; higher levels are related to DVT risk. Thus, P-selectin may play a role in CVI pathophysiology.

Objective:

We evaluated whether higher levels of soluble P-selectin are a risk factor for CVI.

Methods:

Data were collected from the San Diego Population Study, an established cohort of 2,404 men and women, in whom CVI was evaluated by symptoms, physical examination, and duplex venous ultrasound. A case-control study was conducted within the cohort to analyze the association of P-selectin with risk and severity of CVI. 352 controls without venous abnormalities were matched by age, race, and sex to 352 cases. Cases consisted of four groups with increasing severity of CVI based on clinical and imaging characteristics. Soluble P-selectin was measured in cases and controls using a commercial immunoassay. Multivariable models were used to determine associations of P-selectin with CVI, controlling for potential confounders.

Results:

P-selectin levels did not differ by CVI risk factors including age, sex, race, body mass index (BMI), smoking status, diabetes, prior DVT, venous surgery, and history of cancer (not shown). Overall, P-selectin was not associated with risk of CVI. However, comparing the two most severe case groups to controls, the age, sex, and race adjusted odds ratios (ORs) of CVI for P-selectin in the top two versus bottom tertiles were increased at 1.4 and 2.3, respectively (see table), with the top tertile OR being statistically significant. The association of P-selectin in the top tertile with CVI were slightly weakened with adjustment for BMI, as the case groups with higher P-selectin levels had on average a higher BMI. Successive addition of other risk factors to the model, shown in the table, had no impact on the ORs.

Odds ratios of chronic venous insufficiency with P-selectin
2 highest case groups (80 cases) vs all 352 controls
Tertile 2Tertile 3
Age, Sex, Race 1.4 (0.7–2.7) 2.3 (1.2–4.2) 
    + BMI 1.4 (0.7–2.7) 1.9 (1.0–3.6) 
    + History of Venous Thrombosis 1.4 (0.7–3.0) 1.8 (0.9–3.7) 
    + Smoking History 1.5 (0.7–3.0) 1.9 (0.9–3.8) 
    + FHx of Venous Ulcer 1.5 (0.7–3.1) 1.9 (0.9–3.8) 
    + History of Cancer 1.5 (0.7–3.2) 1.9 (0.9–3.7) 
BMI=Body Mass Index FHx=Family History 
OR (95% CI) with Tertile 1 as reference level 
Odds ratios of chronic venous insufficiency with P-selectin
2 highest case groups (80 cases) vs all 352 controls
Tertile 2Tertile 3
Age, Sex, Race 1.4 (0.7–2.7) 2.3 (1.2–4.2) 
    + BMI 1.4 (0.7–2.7) 1.9 (1.0–3.6) 
    + History of Venous Thrombosis 1.4 (0.7–3.0) 1.8 (0.9–3.7) 
    + Smoking History 1.5 (0.7–3.0) 1.9 (0.9–3.8) 
    + FHx of Venous Ulcer 1.5 (0.7–3.1) 1.9 (0.9–3.8) 
    + History of Cancer 1.5 (0.7–3.2) 1.9 (0.9–3.7) 
BMI=Body Mass Index FHx=Family History 
OR (95% CI) with Tertile 1 as reference level 
View Large
Conclusions:

Higher levels of soluble P-selectin are associated with risk of more severe, but not mild, CVI. This suggests that thrombosis potential or platelet function is important in the pathogenesis of this disease.

Disclosures:

No relevant conflicts of interest to declare.

Topics:
chronic venous insufficiency, p-selectin, cortical blindness, deep vein thrombosis, cancer, thrombus, brachial plexus neuritis, cell adhesion molecules, diabetes mellitus, diabetes mellitus, type 2

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2010 by The American Society of Hematology
2010
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