Is Higher Soluble P-Selectin a Risk Factor for Chronic Venous Insufficiency?

Abstract

AbstractAbstract 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-selectin2 highest case groups (80 cases) vs all 352 controlsTertile 2Tertile 3Age, Sex, Race1.4 (0.7–2.7)2.3 (1.2–4.2)+ BMI1.4 (0.7–2.7)1.9 (1.0–3.6)+ History of Venous Thrombosis1.4 (0.7–3.0)1.8 (0.9–3.7)+ Smoking History1.5 (0.7–3.0)1.9 (0.9–3.8)+ FHx of Venous Ulcer1.5 (0.7–3.1)1.9 (0.9–3.8)+ History of Cancer1.5 (0.7–3.2)1.9 (0.9–3.7)BMI=Body Mass Index FHx=Family HistoryOR (95% CI) with Tertile 1 as reference level 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.