Varicose Veins and Heart Failure: Reading the Evidence
Do varicose veins cause heart failure? The research does not show that they do. Large population studies find that people with varicose veins are diagnosed with heart failure somewhat more often, but a link is not a cause, and genetic studies built to test cause point to no effect or a very small one. The clearer arrow runs the other way: a failing heart can swell the legs.
For clots and the wider circulation, see varicose veins, blood clots and the heart.
The Heart Failure Numbers, Study by Study
The largest study, published in PLOS ONE in 2025, followed 390,436 South Korean adults for a median of 13.3 years. People with a recorded diagnosis of varicose veins developed heart failure at a rate about 17 per cent higher than matched people without them (hazard ratio 1.17).
A Taiwanese national study of 4,644 people with varicose veins, in BMJ Open in 2020, found more deaths and major cardiovascular events than in matched controls. The excess was heaviest in people with ulcers or inflamed veins, whose risks of heart failure, acute coronary syndrome, stroke and venous clots were at least doubled.
Germany's Gutenberg Health Study, in the European Heart Journal in 2021, examined 12,423 adults aged 40 to 80. Advanced vein disease, with swelling or skin change, affected 40.8 per cent and predicted death from any cause over 6.4 years (hazard ratio 1.46), independent of other illnesses and medication.
A September 2026 systematic review in the American Heart Journal Plus pooled five such cohorts. Heart failure and stroke risks pointed the same way, with wide differences between studies, and the more advanced the vein disease, the higher the cardiovascular risk. A larger 2026 meta-analysis of 13 studies (6.4 million people) found heart disease and deaths from any cause each about 30 per cent more common with chronic venous disease.
So the association is real but modest, and describes populations, not a forecast for one person.
Why a Link Is Not the Same as a Cause
The two conditions share background risks. In the German study, vein disease travelled with age, female sex, high blood pressure, obesity, smoking and existing cardiovascular disease, several of which also drive heart failure. Statistical adjustment narrows that overlap but never removes it, and the overlap varies by population: in a Tehran cohort of 1,176 adults, vein disease affected 36.5 per cent but showed no meaningful link with high blood pressure, diabetes or smoking.
Mendelian randomisation tests cause more directly, using the genes people are born with as a natural experiment. Two such studies appeared in 2024, and they disagree. One, in Medicine, found that a genetic tendency to varicose veins went with a very small rise in heart failure risk (odds ratio 1.03). The other, in Reviews in Cardiovascular Medicine, found that a genetic tendency to venous insufficiency went with a slightly lower risk (odds ratio 0.96), which faded once clots, ulcers, obesity, smoking and alcohol were accounted for. The same genes can drive both conditions: a UK genetic analysis in the Journal of the American Heart Association found that genetically larger body size, carried into adult life, raises the risk of both heart failure and varicose veins.
Taken together, the genetic evidence points to no causal effect or a very small one, and does not support the idea that leg veins are a meaningful cause of heart failure.
When the Arrow Points From the Heart to the Legs
A heart that pumps poorly raises pressure in the veins returning to it, and fluid gathers in the legs. The NHS lists swelling in the feet, ankles and legs, and breathlessness with everyday activity or when lying down among the symptoms of heart failure. A 2025 review in Heart Failure Reviews describes each condition feeding the other.
Swelling in both legs, with breathlessness, tiredness or sudden weight gain, is not put down to varicose veins until the heart has been considered. In a Dubai summer, swollen ankles are easily blamed on the heat. Swelling with breathlessness is not a heat problem and needs prompt medical review.
What the Evidence Means for Your Legs
Varicose veins are not a heart diagnosis, and the NHS notes that varicose veins do not usually cause any serious problems. The studies do suggest that varicose veins, and advanced chronic venous insufficiency in particular, often come with blood pressure, weight and smoking risks worth checking with your doctor.
We found no trial or cohort study testing whether treating varicose veins lowers heart failure risk. Two record studies found fewer artery problems (Taiwan, 2021) and fewer deaths (2025) after vein procedures, but treated people may be healthier to begin with. So varicose veins treatment is decided on leg symptoms and on what a duplex ultrasound shows, not offered as heart protection. If you already have heart failure, tell your vascular surgeon: it changes how swelling is read and how compression and any procedure are planned. Clot risk is a separate question, answered in does treating varicose veins lower your clot risk.
NICE guidance asks clinicians to explain the likely course and possible complications of varicose veins and to address any misconceptions about those risks. Dr. Sohrabi's practice follows that guidance, which here means keeping a measured association separate from a cause.
Dr. Soroush Sohrabi is a UK-trained Consultant Vascular and Endovascular Surgeon (FRCS, CCT) practising in Dubai, with a Cleveland Clinic Advanced Endovascular Fellowship and 77 peer-reviewed publications.
Choosing a Surgeon When Swelling May Not Be From the Veins
Look for specialist vascular training, a surgeon who scans the veins personally, and a willingness to look beyond the leg when the pattern points elsewhere. Dr. Sohrabi holds the FRCS in Vascular Surgery and a CCT, performs and interprets his own duplex scans, and arranges an echocardiogram and a cardiology referral when swelling suggests a heart cause. Book a consultation to have your veins assessed.
About the Author
Dr. Soroush Sohrabi MD, PhD, FRCS, CCT (UK), PGCert, MCPhleb is a Consultant Vascular and Endovascular Surgeon practising in Dubai. He trained in the United Kingdom and holds a Fellowship of the Royal College of Surgeons (FRCS) in Vascular Surgery and a Certificate of Completion of Training (CCT). He has published 77 peer-reviewed papers with over 1,183 academic citations and is a member of the European Society for Vascular Surgery (ESVS) and the Vascular Society of Great Britain and Ireland (VSGBI). He is licensed by the UK General Medical Council (GMC No. 5207627) and the Dubai Health Authority (DHA No. 48905551).
Medically reviewed by Dr. Soroush Sohrabi MD, PhD, FRCS, CCT, Consultant Vascular and Endovascular Surgeon, October 2026.
References
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