Study objective-To determine the prevalence of varicose veins and chronic venous insuYciency (CVI) in the general population. Design-Cross sectional survey. Setting-City of Edinburgh. Participants-Men and women aged 18-64 years selected randomly from age-sex registers of 12 general practices. Main results-In 1566 subjects examined, the age adjusted prevalence of trunk varices was 40% in men and 32% in women (p<0.01). This sex diVerence was mostly a result of higher prevalence of mild trunk varices in men. More than 80% of all subjects had mild hyphenweb and reticular varices. The age adjusted prevalence of CVI was 9% in men and 7% in women (p<0.05). The prevalence of all categories of varices and of CVI increased with age (p<0.001). No relation was found with social class. Conclusions-Approximately one third of men and women aged 18-64 years had trunk varices. In contrast with the findings in most previous studies, mainly conducted in the 1960s and 1970s, chronic venous insuYciency and mild varicose veins were more common in men than women. No evidence of bias in the study was found to account for this sex diVerence. Changes in lifestyle or other factors might be contributing to an alteration in the epidemiology of venous disease. (J Epidemiol Community Health 1999;53:149-153)

Subjects with asymptomatic peripheral arterial disease appear to have the same increased risk of cardiovascular events and death found in claudicants.

Summary.We examined the relationships of whole blood viscosity and its major determinants to incident cardiovascular events (ischaemic heart disease and stroke) in a prospective study of a random population sample of 1592 men and women aged 55-74 years (the Edinburgh Artery Study). 272 fatal and non-fatal cardiovascular events occurred during 5 years of follow-up (cumulative incidence 17 . 1%). Age and sex adjusted mean levels of blood viscosity (3 . 70 v 3 . 55 mPa.s), haematocrit (46 . 2 v 45 . 7%), haematocrit-corrected blood viscosity (3 . 57 v 3 . 48 mPa.s), plasma viscosity (1 . 35 v 1 . 33 mPa.s) and fibrinogen (2 . 88 v 2 . 67 g/l) were significantly higher in subjects who experienced events than in subjects who did not. The relationships of these rheological variables to cardiovascular events were at least as strong as those of conventional risk factors (smoking habit, diastolic blood pressure, and low-density lipoprotein cholesterol). After adjustment for these conventional risk factors, the associations of blood viscosity and haematocrit remained significant for stroke, but not for total events; whereas the associations of plasma viscosity and fibrinogen remained significant for total events and for stroke.These findings suggest that increased blood viscosity may be one plausible biological mechanism through which increases in haematocrit and fibrinogen may promote ischaemic heart disease and stroke. Randomized controlled trials of viscosity reduction in the prevention of cardiovascular events (e.g. by lowering high levels of haematocrit or plasma fibrinogen) are suggested.

A case-control study on chewing and smoking habits and oral submucous fibrosis (OSF) was undertaken in Karachi in 1989/90. Cases were patients detected with fibrous bands and leathery mucosa and hospital-based controls were matched by age and sex. Information on habits was collected by personal interview of 157 cases and 157 controls. Despite overall female preponderance, a substantial number of young men were enlisted. The male/female risks were found to be similar. Immigrants from India to Pakistan (Mohajir) had a similar risk status to local Punjabis. No differences between risks were found when comparing the three age categories, 21, 21-40, 41-60 yr. Among the cases, an increased risk was observed for areca nut chewing. This habit when practised alone appeared to have the highest risk (RR 154), followed by pan with or without tobacco (RR 64, 32 respectively). Logistic regression and discriminant analysis showed that daily consumption rates appeared to be more important with respect to risk than lifetime duration of habit. Tobacco habits were more prevalent amongst those 15 cases who presented with concurrent carcinoma and OSF: We conclude that areca nut chewing has a causal relationship with OSF: additional tobacco insult may be necessary for subsequent carcinoma development.