Sex differences in symptom severity and clusters in patients with chronic venous disease

Problem: The burden of symptoms associated with chronic venous disease (CVeD) is poorly understood, under-recognized, and ill-managed. Symptom research is central to tailoring effective treatments and improving health.

Purpose: To determine whether there are differences in leg symptoms and symptom clusters between men and women with CVeD.

Methods: Data were collected at baseline from 264 patients, with an 11-item VEINES-SYM questionnaire, enrolled in a randomized clinical trial that examined cooling pack applications to prevent venous leg ulcers. Symptom clusters were defined as three or more concurrent symptoms that occurred at least weekly.

Analysis: An intrinsic scoring algorithm was used to calculate overall scores for each item by sex. Exploratory factor analysis identified symptom clusters (factors) using oblique rotation to account for correlations between factors.

Results: Average age was 61.7 years; 54.5% female, 58% African American or black, 60.6% had diabetes. Top three symptoms for women in order of frequency: achy legs, swelling and pain; for men, swelling, achy legs and heavy legs. For the total group, two symptom clusters, Distressful and Discomfort were noted. No statistically significant differences were observed in factor scores between females and males. For sex, different factor loadings for symptom clusters were observed; females reported Hurting and Annoying clusters; males, Nagging and Irritating.  

Discussion: Findings suggest differences in CVeD symptoms and clusters by sex.  The symptoms in each of the two clusters differed, however, consistency was noted in the factors associated with each. Two clusters in each group were characterized by neuropathic type symptoms (Hurting and Nagging), the other (Annoying and Irritating) were nocioceptive in nature.  Co-morbid conditions (diabetes) and sex differences in pain responses may play a role in the presentation of symptoms.  This study supports the need for increased sex-delineated clinical assessment and consideration of potential differences required in the management of CVeD symptoms.