Chronic Venous Disease (CVD)

Chronic venous disease (CVD), also known as chronic venous insufficiency (CVI), is a condition where the veins in the legs fail to efficiently return blood back to the heart. This occurs due to malfunctioning or weakened valves within the veins, causing blood to flow backward (venous reflux) and pool in the legs.

Over time, this pooling increases pressure within the veins, leading to venous hypertension, which can cause damage to both large veins and the microcirculation, resulting in symptoms and complications.

The impact CVD has on healthcare, both patients affected, and financial impact is high. CVD uses 2% of the US healthcare budget, amounting to $15 billion annually. (1)

(Image from Focal Point Substack)

Causes

• Valves in veins can become incompetent due to congenital defects, injury, inflammation (phlebitis), or excessive distention from hormonal effects or prolonged high pressure.
• Blood flow can be impaired by blockages such as deep vein thrombosis (DVT), venous stenosis, or external compression.
• Weakness in calf muscles reduces their ability to assist blood return, exacerbating venous hypertension.
• Persistent high venous pressure leads to microangiopathic changes including capillary dilation, endothelial (cells lining the veins) damage, and increased edema. These changes can progress to skin alterations and ulceration. (2,3)

Symptoms (2,3)

• Swelling in legs and ankles (often first noticeable symptom)
• Varicose veins
• Leg pain or sensations of heaviness, tightness, tiredness, aching, or restlessness
• Skin discoloration (hyperpigmentation), leathery texture, flaky skin
• Itching
• Stasis dermatitis (skin inflammation)
• Lipodermatosclerosis (hardening of skin and subcutaneous tissue)
• Venous ulcers, typically around ankles

Risk Factors (3)

• Advanced age due to natural wear on vein valves.
• Women due to hormone and pregnancy-related pressures on pelvic veins.
• Genetic predisposition.
• Overweight/obesity.
• Sedentary lifestyle.
• History of clots damage vein walls and valves, increasing likelihood of CVD development.
• Tobacco use.

Bromelain (4)

Bromelain, naturally derived from pineapple stem, is a proteolytic enzyme with an amazing profile:

• Reduces inflammation by modulating inflammatory mediators like interleukin and tumor necrosis factor.
• Breaks down fibrin, a protein that contributes to clotting and poor circulation in venous disorders.
• Protects endothelial cells from damage caused by hypoxia (low oxygen levels).
• Decreases venous edema and improves symptoms like heaviness and swelling in the legs.

Vitamin C (5)

A rich source of vitamin C is found in broccoli, citrus, and other fruits and vegetables. It is a natural antihistamine, anti-inflammatory, and antioxidant:

• Supports the production of collagen and elastin, essential for maintaining strong and elastic vein walls.
• Protects vein membranes from oxidative stress caused by free radicals.
• Enhances blood flow by strengthening fragile vessel walls, preventing pooling of blood in the lower extremities.

Bromelain and Vitamin C - Better Together (6)

When combined, bromelain's anti-inflammatory and fibrinolytic properties complement vitamin C's ability to strengthen vein walls and reduce oxidative stress. This combination also:

• Alleviates inflammation and swelling associated with CVD.
• Promotes better circulation by improving vessel integrity and reducing clot formation.
• Protects endothelial cells from hypoxic (low oxygen levels) damage, enhancing capillary function.
• Strengthens integrity of fragile blood vessel walls, resulting in increased vein integrity and capillary function.

Citations

1. Davies AH. The Seriousness of Chronic Venous Disease: A Review of Real-World Evidence. Adv Ther. 2019 Mar;36(Suppl 1):5-12. doi: 10.1007/s12325-019-0881-7.
2. McCullough, P. A. Role of bromelain and vitamin C in chronic venous disease. The Focal Points. Source
3. Society for Vascular Surgery. What is chronic venous disease? Venous Forum. Source
4. Rathnavelu V, Alitheen NB, et al. Potential role of bromelain in clinical and therapeutic applications. Biomed Rep. 2016 Sep;5(3):283-288. doi: 10.3892/br.2016.720.
5. May JM, Harrison FE. Role of vitamin C in the function of the vascular endothelium. Antioxid Redox Signal. 2013 Dec 10;19(17):2068-83. doi: 10.1089/ars.2013.5205.
6. PubMed Link

Written By Brooke Lounsbury