Chronic venous insufficiency

disease
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Also known as chronic venous insufficiency (disease)venous insufficiency (disease), chronic

Summary

Chronic venous insufficiency (MONDO:0000492) is a disease with 12 cohort genes (15 GWAS associations across 6 studies) and 73 clinical trials. The dominant Reactome pathway is Activation of anterior HOX genes in hindbrain development during early embryogenesis (4 cohort genes). Top therapeutic interventions include diosmin, coumarin, and troxerutin.

At a glance

  • Cohort genes: 12
  • GWAS associations: 15
  • Clinical trials: 73

Clinical features

No curated clinical features (Orphanet) for this disease.

Identifiers

Disease identifiers

FieldValue
Canonical namechronic venous insufficiency
Mondo IDMONDO:0000492
DOIDDOID:0050853
UMLSC1306557
MedGen727071
Is cancer (heuristic)no

Also known as: chronic venous insufficiency (disease) · venous insufficiency (disease), chronic

Data availability: 15 GWAS associations (6 studies).

Disease family

Classification path: disease › human disease › disease by body system or component › cardiovascular disordervascular disordervein disordervenous insufficiencychronic venous insufficiency

Related subtypes (1): post-thrombotic syndrome

Genetics & variants

GWAS landscape

15 GWAS associations across 6 studies. Top hits map to 7 distinct genes (as reported by GWAS).

Top associations by p-value

rsIDp-valueGeneRisk alleleOdds ratio
rs620484027e-38FTOG0.12
rs345769225e-35SLC12A2-DTC0.13
rs18946923e-33SLC19A2 - F5G0.34
rs560946412e-30FTOA0.11
rs1154787352e-18ABOA0.1
rs621062521e-12LINC01865G0.17
rs94966144e-12PRDX2P4 - SIM1T0.07
chr18:578504226e-12G0.07
rs7271395e-11KCNH8A1.37
rs172786652e-08EFEMP1G1.32
rs20301363e-07SKAP2C1.25

Top studies (by case count)

StudyLead authorYearCasesControlsTitle
GCST90476016Verma A202425,476408,634Diversity and scale: Genetic architecture of 2068 traits in the VA Million Veteran Program.
GCST90478045Verma A20245,227112,387Diversity and scale: Genetic architecture of 2068 traits in the VA Million Veteran Program.
GCST90480227Verma A20245,227112,387Diversity and scale: Genetic architecture of 2068 traits in the VA Million Veteran Program.
GCST90478044Verma A20242,12156,059Diversity and scale: Genetic architecture of 2068 traits in the VA Million Veteran Program.
GCST004343Ellinghaus E20173234,619Genome-wide association analysis for chronic venous disease identifies EFEMP1 and KCNH8 as susceptibility loci.
GCST90436181Zhou W2018188369,592Efficiently controlling for case-control imbalance and sample relatedness in large-scale genetic association studies.

Variant details and genetic-evidence tiers

Tier distribution (top 50 variants)

TierVariants
Tier 1: coding0
Tier 2: splice/UTR0
Tier 3: regulatory0
Tier 4: intronic/intergenic11

MAF distribution

BucketVariants
common (>=0.05)9
low_freq (0.01-0.05)2
rare (<0.01)0
unknown0

Functional consequences

ConsequenceCount
intron_variant9
non_coding_transcript_exon_variant1
unknown1

Top variants

rsIDChrPosAllelesMAFConsequenceGenep-valueTier
rs620484021653769311G>A,T0.403intron_variantFTO7e-38Tier 4: intronic/intergenic
rs345769225128028411C>G0.23intron_variantSLC12A2-DT5e-35Tier 4: intronic/intergenic
rs18946921169498416G>A0.037non_coding_transcript_exon_variantSLC19A2 - F53e-33Tier 4: intronic/intergenic
rs560946411653772541A>G,T0.332intron_variantFTO2e-30Tier 4: intronic/intergenic
rs1154787359133274295A>T0.193intron_variantABO2e-18Tier 4: intronic/intergenic
rs621062522408713G>A0.044intron_variantLINC018651e-12Tier 4: intronic/intergenic
rs94966146100165675T>A,C0.255intron_variantPRDX2P4 - SIM14e-12Tier 4: intronic/intergenic
chr18:578504220.2326e-12Tier 4: intronic/intergenic
rs727139319293203A>G0.21intron_variantKCNH85e-11Tier 4: intronic/intergenic
rs17278665255868859C>A,G0.15intron_variantEFEMP12e-08Tier 4: intronic/intergenic
rs2030136726851397T>C0.24intron_variantSKAP23e-07Tier 4: intronic/intergenic

Genes & proteins

Mendelian disease overlap and somatic drivers

GenCC: 0 · Orphanet: 6 · OMIM-shared: 0 · Dual-evidence (GWAS+Mendelian): 0

Orphanet rare-disease linkage (cohort genes)

GeneOrphanet IDRare disease
EFEMP1Orphanet:75376Familial drusen
EFEMP1Orphanet:98977Juvenile glaucoma
HOXA1Orphanet:69737Bosley-Salih-Alorainy syndrome
HOXA1Orphanet:69739Athabaskan brainstem dysgenesis syndrome
HOXA2Orphanet:140963Bilateral microtia-deafness-cleft palate syndrome
HOXA2Orphanet:83463Microtia

Cohort genes → proteins

12 cohort genes, 9 distinct canonical proteins.

Evidence partition

SubsetGenes
gwas_only12

Cohort genes (full)

SymbolHGNCEnsemblUniProtNameEvidence
SKAP2HGNC:15687ENSG00000005020O75563Src kinase-associated phosphoprotein 2gwas
KCNH8HGNC:18864ENSG00000183960Q96L42Voltage-gated delayed rectifier potassium channel KCNH8gwas
LINC02860HGNC:22364ENSG00000222004long intergenic non-protein coding RNA 2860gwas
EFEMP1HGNC:3218ENSG00000115380Q12805EGF-containing fibulin-like extracellular matrix protein 1gwas
HOTAIRM1HGNC:37117ENSG00000233429HOXA transcript antisense RNA, myeloid-specific 1gwas
HOXA-AS3HGNC:43748ENSG00000254369HOXA cluster antisense RNA 3gwas
HOXA1HGNC:5099ENSG00000105991P49639Homeobox protein Hox-A1gwas
HOXA2HGNC:5103ENSG00000105996O43364Homeobox protein Hox-A2gwas
HOXA3HGNC:5104ENSG00000105997O43365Homeobox protein Hox-A3gwas
HOXA4HGNC:5105ENSG00000197576Q00056Homeobox protein Hox-A4gwas
HOXA5HGNC:5106ENSG00000106004P20719Homeobox protein Hox-A5gwas
HOXA6HGNC:5107ENSG00000106006P31267Homeobox protein Hox-A6gwas

Cohort function summary

Lead sentence per gene, UniProt-curated.

SymbolProtein nameFunction (lead sentence)
SKAP2Src kinase-associated phosphoprotein 2May be involved in B-cell and macrophage adhesion processes.
KCNH8Voltage-gated delayed rectifier potassium channel KCNH8Pore-forming (alpha) subunit of a voltage-gated delayed rectifier potassium channel that mediates outward-rectifying potassium currents.
EFEMP1EGF-containing fibulin-like extracellular matrix protein 1Binds EGFR, the EGF receptor, inducing EGFR autophosphorylation and the activation of downstream signaling pathways.
HOXA1Homeobox protein Hox-A1Sequence-specific transcription factor.
HOXA2Homeobox protein Hox-A2Sequence-specific transcription factor which is part of a developmental regulatory system that provides cells with specific positional identities on the anterior-posterior axis.
HOXA3Homeobox protein Hox-A3Sequence-specific transcription factor which is part of a developmental regulatory system that provides cells with specific positional identities on the anterior-posterior axis.
HOXA4Homeobox protein Hox-A4Sequence-specific transcription factor which is part of a developmental regulatory system that provides cells with specific positional identities on the anterior-posterior axis.
HOXA5Homeobox protein Hox-A5Sequence-specific transcription factor which is part of a developmental regulatory system that provides cells with specific positional identities on the anterior-posterior axis.
HOXA6Homeobox protein Hox-A6Sequence-specific transcription factor which is part of a developmental regulatory system that provides cells with specific positional identities on the anterior-posterior axis.

Protein-family classification

Druggable: 1 · Difficult: 7 · Unknown: 4 · Druggable fraction: 0.08

Family distribution

Cohort families vs a genome-wide background (hypergeometric, BH-FDR; fold = observed/expected). Counts kept; sorted by enrichment, so the catch-all Other/Unknown bucket no longer leads.

FamilyGenesFoldFDR
Transcription factor64.1×0.006
Ion channel19.3×0.205
Scaffold/PPI11.4×0.681
Other/Unknown40.6×0.969

Per-gene assignment

SymbolFamilyDruggable?ECInterPro (top 3)
SKAP2Scaffold/PPInoSH3_domain, PH_domain, PH-like_dom_sf
KCNH8Ion channelyesPAS, cNMP-bd_dom, PAS-assoc_C
LINC02860Other/Unknownno
EFEMP1Other/UnknownnoEGF-type_Asp/Asn_hydroxyl_site, EGF, EGF-like_Ca-bd_dom
HOTAIRM1Other/Unknownno
HOXA-AS3Other/Unknownno
HOXA1Transcription factornoHD, Homeodomain-like_sf, Homeobox_CS
HOXA2Transcription factornoHD, Homeobox_Antennapedia_CS, Homeodomain-like_sf
HOXA3Transcription factornoHD, Homeobox_Antennapedia_CS, Homeodomain-like_sf
HOXA4Transcription factornoHD, Homeobox_Antennapedia_CS, Homeodomain-like_sf
HOXA5Transcription factornoHD, Homeobox_Antennapedia_CS, Homeodomain-like_sf
HOXA6Transcription factornoHD, Homeobox_Antennapedia_CS, Homeodomain-like_sf

Expression context

Cohort genes with no expression data: 0.

7 cohort genes are a single-cell marker in ≥1 SCXA experiment.

Breadth distribution (Bgee present_calls)

BucketGenes
narrow (1-5 tissues)0
moderate (6-20)0
broad (>20)12
unknown0

Top tissues across cohort

TissueCohort genes
secondary oocyte2
descending thoracic aorta2
right uterine tube2
left uterine tube2
metanephros cortex2
caput epididymis2
corpus epididymis2
pericardium1
sperm1
C1 segment of cervical spinal cord1
corpus callosum1
endothelial cell1
left testis1
male germ line stem cell (sensu Vertebrata) in testis1
right testis1
right coronary artery1
thoracic aorta1
lower esophagus1
lower esophagus mucosa1
colonic epithelium1

Per-gene tissue summary (top 30)

SymbolBgee breadthFANTOM5 breadthSCXATop tissues
SKAP2287ubiquitousmarkersperm, secondary oocyte, pericardium
KCNH8168broadmarkercorpus callosum, endothelial cell, C1 segment of cervical spinal cord
LINC0286041tissue_specificyesmale germ line stem cell (sensu Vertebrata) in testis, left testis, right testis
EFEMP1286ubiquitousmarkerright coronary artery, thoracic aorta, descending thoracic aorta
HOTAIRM1130ubiquitousmarkerlower esophagus mucosa, right uterine tube, lower esophagus
HOXA-AS3108tissue_specificyescolonic epithelium, left uterine tube, metanephros cortex
HOXA1142broadmarkeresophagus squamous epithelium, secondary oocyte, hair follicle
HOXA2133broadyesbuccal mucosa cell, mucosa of transverse colon, descending thoracic aorta
HOXA3192ubiquitousmarkercaput epididymis, corpus epididymis, right uterine tube
HOXA4111broadyesesophagogastric junction muscularis propria, mucosa of stomach, lower esophagus muscularis layer
HOXA5203broadmarkeradrenal tissue, caput epididymis, corpus epididymis
HOXA6114yesleft uterine tube, stromal cell of endometrium, metanephros cortex

Protein interactions among cohort

Intra-cohort edges: 2.

Hub genes (top 10 by interactor count)

SymbolInteractor count
EFEMP12,988
HOXA12,373
HOXA51,562
HOXA21,256
HOXA31,203
KCNH81,116
SKAP21,029
HOXA4882
HOXA6681
LINC028600

Intra-cohort edges

ABSources
HOXA3HOXA6string_interaction
HOXA5HOXA6string_interaction

Structural data

PDB: 1 · AlphaFold-only: 8 · No structure: 3

Cohort genes with PDB structures (top 30)

SymbolUniProtPDB entries
SKAP2O755631

AlphaFold-only cohort genes (top 30 by pLDDT)

SymbolUniProtpLDDT
EFEMP1Q1280577.67
HOXA6P3126764.92
KCNH8Q96L4264.41
HOXA5P2071964.02
HOXA4Q0005663.88
HOXA3O4336559.41
HOXA1P4963959.15
HOXA2O4336458.47

Function

Pathway analysis

Distinct Reactome pathways touched by cohort: 9. Enrichment computed across 12 evidence-associated genes (8 with Reactome annotation).

Pathways by enrichment

Over-representation of cohort genes vs the genome-wide background (hypergeometric test, Benjamini-Hochberg FDR; fold = observed/expected over 8 annotated cohort genes). Counts and members are kept as ground-truth; sorted by enrichment.

PathwayCohort genesFoldFDRSample cohort genes
Activation of anterior HOX genes in hindbrain development during early embryogenesis445.7×8e-06HOXA1, HOXA2, HOXA3, HOXA4
Signal regulatory protein family interactions184.0×0.038SKAP2
Formation of the nephric duct179.3×0.038HOXA6
Molecules associated with elastic fibres138.6×0.058EFEMP1
Voltage gated Potassium channels130.4×0.058KCNH8
Cell-Cell communication117.2×0.075SKAP2
Potassium Channels116.8×0.075KCNH8
Regulation of expression of SLITs and ROBOs18.7×0.124HOXA2
Neuronal System15.5×0.167KCNH8

GO biological processes by enrichment

Over-representation of cohort genes vs the genome-wide background (hypergeometric test, Benjamini-Hochberg FDR; fold = observed/expected over 9 annotated cohort genes). Counts and members are kept as ground-truth; sorted by enrichment.

GO termCohort genesFoldFDRSample cohort genes
anterior/posterior pattern specification5100.7×5e-08HOXA2, HOXA3, HOXA4, HOXA5, HOXA6
embryonic skeletal system morphogenesis3130.6×6e-05HOXA3, HOXA4, HOXA5
thyroid gland development2120.8×0.003HOXA3, HOXA5
rhombomere 3 morphogenesis11872.4×0.008HOXA2
semicircular canal formation11872.4×0.008HOXA1
regulation of transcription by RNA polymerase II56.5×0.008HOXA1, HOXA2, HOXA3, HOXA5, HOXA6
optokinetic behavior1936.2×0.009HOXA1
rhombomere 2 development1936.2×0.009HOXA2
abducens nerve formation1936.2×0.009HOXA1
specification of animal organ position1624.1×0.009HOXA3
brain segmentation1624.1×0.009HOXA2
post-embryonic eye morphogenesis1624.1×0.009EFEMP1
lung goblet cell differentiation1624.1×0.009HOXA5
trachea cartilage morphogenesis1624.1×0.009HOXA5
mesenchymal-epithelial cell signaling1624.1×0.009HOXA5
cell-cell signaling involved in mammary gland development1624.1×0.009HOXA5
anatomical structure morphogenesis230.9×0.009HOXA1, HOXA4
glossopharyngeal nerve morphogenesis1468.1×0.009HOXA3
intestinal epithelial cell maturation1468.1×0.009HOXA5
positive regulation of transcription by RNA polymerase II46.6×0.009HOXA1, HOXA2, HOXA4, HOXA5
positive regulation of myeloid cell differentiation1374.5×0.010HOXA5
animal organ formation1374.5×0.010HOXA3
bronchiole development1374.5×0.010HOXA5
regulation of mammary gland epithelial cell proliferation1312.1×0.011HOXA5
parathyroid gland development1267.5×0.013HOXA3
segment specification1234.1×0.014HOXA2
magnesium ion homeostasis1208.1×0.015HOXA3
embryonic neurocranium morphogenesis1208.1×0.015HOXA1
embryonic viscerocranium morphogenesis1187.2×0.015HOXA2
lung-associated mesenchyme development1187.2×0.015HOXA5

Therapeutics

Drug target analysis

Approved (phase 4): 0 · Phase ≥3: 0 · Phased (≥1): 0 · Undrugged: 12

Druggability breadth: 1 of 12 evidence-associated genes (8%) have a ChEMBL target (buckets above are over the deeply-mined display cohort).

Top cohort targets by molecule count

SymbolMoleculesMax phase
SKAP200
KCNH800
LINC0286000
EFEMP100
HOTAIRM100
HOXA-AS300
HOXA100
HOXA200
HOXA300
HOXA400

Bioactivity and enzyme data

Enzyme cohort genes (≥1 EC): 0.

Cohort genes with ChEMBL bioactivity (full, sorted by assay count)

SymbolAssaysType breakdown
KCNH821Binding:20, Toxicity:1

Pharmacogenomics

Cohort genes with a PharmGKB record: 10; with CPIC/DPWG dosing guidelines: 0.

No cohort gene has a CPIC/DPWG genotype-guided dosing guideline (PharmGKB).

Chemical tractability of cohort targets

0 approved/phased compounds have measured bioactivity against a cohort gene (and aren’t yet in disease-level trials). This is a research / tractability signal, NOT a therapeutic recommendation — a bioactivity row often reflects off-target or screening binding (e.g. promiscuous kinase inhibitors against a cohort kinase), implying no disease mechanism.

Druggability pyramid

Cohort genes binned by druggability tier (high → low):

TierDefinitionGenesSymbols
AApproved (phase 4 drug)0
BPhased (≥1) drug, not yet approved0
CDruggable family + PDB, no drug0
DDruggable family + AlphaFold only, no drug1KCNH8
EDifficult family or no structure, no drug11SKAP2, LINC02860, EFEMP1, HOTAIRM1, HOXA-AS3, HOXA1, HOXA2, HOXA3, HOXA4, HOXA5 (+1 more)

Undrugged target profiles

12 cohort genes are undrugged. Ranked by ‘starting-point quality’ (assay depth + drugged-partner adjacency).

SymbolChEMBL assaysDrugged partners (top 3)
SKAP20
KCNH821
LINC028600
EFEMP10
HOTAIRM10
HOXA-AS30
HOXA10
HOXA20
HOXA30
HOXA40
HOXA50
HOXA60

Clinical trials & evidence

Clinical trials

Clinical trials: 73.

Phase distribution (across all retrieved trials)

PhaseTrials
Not specified57
PHASE49
PHASE34
PHASE12
PHASE2/PHASE31

Top trials by phase / activity

NCTPhaseStatusTitle
NCT07390097PHASE4NOT_YET_RECRUITINGCalcium Dobesilate After Radiofrequency Ablation for Varicose Veins
NCT01372020PHASE4COMPLETEDNeuromuscular Electrical Therapy in Venous Ulcers
NCT01432795PHASE4COMPLETEDPracticability of Gliding Aids for Medical Compression Stockings
NCT01654016PHASE4COMPLETEDStudy of Antiinflammatory Effects of Detralex (Daflon)
NCT01848210PHASE4COMPLETEDEfficacy and Safety of Coumarin and Troxerutin in the Symptomatic Treatment of Chronic Venous Insufficiency
NCT02236338PHASE4COMPLETEDRadiofrequency Ablation vs Laser Ablation of the Incompetent Greater Saphenous Vein
NCT02248740PHASE4TERMINATEDRadiofrequency Ablation vs. Laser Ablation of the Incompetent Small Saphenous Vein
NCT02346058PHASE4COMPLETEDEfficacy and Safety of Esarin Gel in Chronic Venous Insufficiency and Varicose Veins
NCT06579482PHASE4COMPLETEDClinical Trial of Aesculus Hippocastanum and Associations Versus Diosmina and Hesperidina in Chronic Venous Insuficiency
NCT06232421PHASE2/PHASE3NOT_YET_RECRUITINGClinical Study in Adult Patients With Purulent-inflammatory Processes of the Skin and Soft Tissues, Phase I-II of the Wound Process
NCT01321619PHASE3UNKNOWNEfficacy and Tolerability of the Use of Varicell Compared With Daflon
NCT01402921PHASE3COMPLETEDEfficacy on Volume Reduction and Tolerance of Progressiv’ Medical Compressive Therapy (MCT) V0322 BC in Patients With Chronic Venous Oedema
NCT01477281PHASE3UNKNOWNStudy to Evaluate the Efficacy and Tolerability of Venaflon Use in Reducing the Symptoms Caused by Chronic Venous Insufficiency When Compared With Daflon
NCT02927483PHASE3UNKNOWNStudy to Assess the Efficacy and Safety of Endolex Forte VErsus Diosmin and Hesperidin in Reducing VeNous Insufficiency
NCT01501188PHASE1COMPLETEDEfficacy Study of Kinesio Taping to Treat Muscular and Joint Problems in Chronic Venous Insufficiency
NCT03784131PHASE1UNKNOWNTissue Engineered Veins in Patients With Chronic Venous Insufficiency
NCT04231942Not specifiedACTIVE_NOT_RECRUITINGElastic Compression Stockings and Varicose Veins Recurrence
NCT04253301Not specifiedRECRUITINGFeasibility of the InnoVein Valve and Delivery System for Chronic Venous Insufficiency
NCT05504070Not specifiedACTIVE_NOT_RECRUITINGVenclose digiRF System Post Market Study
NCT06196541Not specifiedACTIVE_NOT_RECRUITINGRespiratory and Physical Functions in Individuals With Chronic Venous Insufficiency
NCT06418282Not specifiedRECRUITINGClinical Study to Evaluate the Effectiveness and Health Economics of a Novel Portable Non-Pneumatic Active Compression Device (NPCD) for Lymphedema/Phlebolymphedema
NCT07449728Not specifiedRECRUITINGThe Influence of Laser Crossectomy With Different Wavelengths on Varicose Vein Progression
NCT00931424Not specifiedUNKNOWNThe Clinical Trial for Primary Chronic Venous Insufficiency
NCT01000909Not specifiedUNKNOWNVenous Pressure Measurement of the Great Saphenous Vein Using Controlled Compression Ultrasound in Healthy Persons and Patients With Chronic Venous Disease as a New Non Invasive Method for Investigation of the Pathophysiology in Primary Varicose Veins
NCT01574911Not specifiedUNKNOWNValidation of a New Method of Limb Volumetry
NCT01899482Not specifiedCOMPLETEDManual Lymphatic Drainage in Chronic Venous Insufficiency: a Randomized Controlled Trial
NCT02015221Not specifiedCOMPLETEDEvaluation of a Dual Action Pneumatic Compression Device: Patient Ease of Use and Comfort
NCT02050061Not specifiedCOMPLETEDChronic Venous Insufficiency; Impact of Compression Stockings on Quality of Life
NCT02215369Not specifiedCOMPLETEDSeCure Endovenous Laser Treatment Study
NCT02395302Not specifiedCOMPLETEDEvaluation of a Dual Action Pneumatic Compression System: Tolerance and Comfort in Patients With Venous Leg Ulcers (VLUs)
NCT02462096Not specifiedTERMINATEDA Feasibility Study of the ReLeaf Catheter System
NCT02559427Not specifiedWITHDRAWNSPA Therapy in the Treatment of Sleep Apnea Syndrome
NCT02662127Not specifiedUNKNOWNEffect of Standing, Lying and Stockings on Blood Bio-markers (v.1)
NCT03104985Not specifiedCOMPLETEDLLLT of Trophic Ulcers of Lower Extremities and Chronic Venous Insufficiency
NCT03216005Not specifiedTERMINATEDInvestigation of Femoropopliteal In Situ Valve Formation With the InterVene System
NCT03283800Not specifiedCOMPLETEDCopper Impact on Venous Insufficiency and Lipodermatosclerosis
NCT03384355Not specifiedUNKNOWNEcchymosis and Coldness in Patients With Varicose Vein
NCT03445091Not specifiedUNKNOWNStudy to Evaluate Impact SANKOM Patent Socks in Patients With CVI
NCT03562546Not specifiedUNKNOWNThe Effect of Structured Exercise on Chronic Venous Insufficiency
NCT03685838Not specifiedUNKNOWNCompression Stockings Therapy Following Mechano-Chemical Ablation (Clarivein®)

Drugs tested across these trials (top 30)

MoleculeMax phaseTrials referencing
DIOSMIN43
COUMARIN41
TROXERUTIN41
CALCIUM DOBESILATE31
HESPERIDIN31
MECRYLATE31