Multi-ancestry Genome-wide Association Study of Varicose Veins Reveals Polygenic Architecture, Genetic Overlap with Arterial and Venous Disease, and Novel Therapeutic Opportunities

ABSTRACT Background Varicose veins represent a common cause of cardiovascular morbidity, with limited available medical therapies. Although varicose veins are heritable and epidemiologic studies have identified several candidate varicose veins risk factors, the molecular and genetic basis remains uncertain. Here, we analyzed the contribution of common genetic variants to varicose veins using data from the VA Million Veteran Program and other large multi-ancestry biobanks. Among 49,765 individuals with varicose veins and 1,334,301 disease-free controls, we identified 139 risk loci. We identified genetic overlap between varicose veins, other vascular diseases, and dozens of anthropometric factors. Using Mendelian randomization, we prioritized novel therapeutic targets via integration of proteomic and transcriptomic data. Finally, topological enrichment analyses confirmed the biologic roles of endothelial shear flow disruption, inflammation, vascular remodeling, and angiogenesis. These findings may facilitate future efforts to develop non-surgical therapies for varicose veins.