rs11967262 — VEGFA

Regulatory variant ~7 kb upstream of VEGFA linked to elevated varicose vein risk through altered vascular endothelial growth factor expression and venous wall remodeling

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VEGFA and Varicose Veins — When Growth Factor Signaling Weakens Vein Walls

Your veins are not passive conduits. They are living structures whose walls depend on a continuous interplay of growth signals, smooth muscle tone, and extracellular matrix remodeling. VEGFA — vascular endothelial growth factor A11 VEGFA — vascular endothelial growth factor A
the master regulator of angiogenesis; controls endothelial proliferation, vessel permeability, and vascular tone through binding to VEGFR1 and VEGFR2 — sits at the center of this balance. The rs11967262 variant lies approximately 7 kb upstream of the VEGFA gene on chromosome 6p21.1, in a region that likely influences VEGFA expression in vascular tissue. Carriers of the G allele show a small but reproducibly elevated risk of developing varicose veins.

Varicose veins affect an estimated 25% of women and 15% of men in Western populations, with heritability estimates ranging from 17–49%. They are not merely cosmetic — dilated, tortuous superficial veins reflect underlying venous hypertension and valve incompetence that, if unchecked, can progress to chronic venous insufficiency, venous ulceration, and superficial thrombophlebitis.

The Mechanism

VEGFA is significantly overexpressed in the walls of varicose veins compared to normal veins. This upregulation is now understood as both a cause and consequence of venous dysfunction. VEGFA is a potent inducer of vascular permeability — it loosens endothelial junctions, allows plasma proteins to leak into the vessel wall, and drives edema. In the venous context, chronically elevated VEGFA signaling through VEGFR2 promotes endothelial cell proliferation and smooth muscle cell phenotypic switching from contractile to synthetic state, weakening the structural integrity of the vein wall.

VEGFA also induces vasodilation through nitric oxide–dependent pathways, reducing venous tone. In the deep venous system this vasodilation is tightly regulated; but in the superficial venous system — which lacks surrounding muscle support — sustained VEGFA overactivity can tip the balance toward stasis, reduced return flow, and progressive dilation. Hypoxia and venous hypertension, which develop as veins dilate and valves fail, further upregulate VEGFA expression in a feed-forward loop.

The rs11967262 variant is intergenic at 6p21.1, ~7 kb upstream of the VEGFA transcription start site22 intergenic at 6p21.1, ~7 kb upstream of the VEGFA transcription start site
the exact regulatory element affected has not been functionally characterized; the association may act through eQTL effects on VEGFA expression in venous endothelial or smooth muscle cells, or through linkage disequilibrium with a causal variant in the VEGFA promoter region. The VEGFA gene has several known regulatory polymorphisms in its 5′ UTR (notably rs2010963) that alter expression levels, and rs11967262 may tag a similar effect.

The Evidence

The primary association evidence comes from the largest varicose vein GWAS published to date. Ahmed et al. 2022 in Nature Communications33 Ahmed et al. 2022 in Nature Communications
two-stage analysis: 22,473 cases and 379,183 controls from UK Biobank; replication in 113,041 cases and 295,928 controls from 23andMe identified 49 genome-wide significant signals across 46 loci. The rs11967262 G allele reached a meta-analysis p-value of 1.45×10⁻¹⁹ with an odds ratio of 1.09 — a modest per-allele effect that is nonetheless very well-powered given the exceptional sample size.

The biological plausibility of the VEGFA locus is strong. The varicose vein wall consistently shows elevated VEGFR1, VEGFR2, and VEGFR3 expression compared to normal venous tissue, particularly in cases complicated by thrombophlebitis. Plasma VEGFA levels are significantly higher in varicose vein patients. A Mendelian randomization study44 Mendelian randomization study
genetically instrumented VEGF levels examined as causal instrument in ~16,000 Europeans found that higher circulating VEGF levels associate with increased venous thromboembolism risk (OR 1.064, 95% CI 1.009–1.122), extending the causal inference beyond simple association.

A separate candidate gene study found the VEGFA promoter variant rs2010963 C allele to be protective against varicose veins55 protective against varicose veins
case-control study of 448 patients and 609 controls in ethnic Russians; C allele OR 0.73, 95% CI 0.59–0.91, p=0.004, directly demonstrating that VEGFA regulatory variants influence varicose vein susceptibility in an allele-specific manner.

The OR of 1.09 per G allele is modest by clinical standards. The absolute risk increase for GG homozygotes compared to CC homozygotes is approximately 18–19% relative risk elevation — meaningful in context of a common, heritable condition but not deterministic. Most GG carriers will not develop clinically significant varicose veins if they manage modifiable risk factors aggressively.

Practical Actions

The VEGFA locus variant acts through venous wall biology — specifically vascular permeability, smooth muscle tone, and extracellular matrix remodeling. Interventions that reduce venous hydrostatic pressure, improve wall tone, and reduce conditions that upregulate VEGFA (hypoxia, venous stasis, inflammation) are directly relevant to this genotype.

Graduated compression garments (20–30 mmHg for prevention; 30–40 mmHg for established insufficiency) mechanically reduce the venous hypertension that drives VEGFA upregulation. Occupations requiring prolonged standing or sitting — which are the strongest modifiable risk factors for varicose veins independent of genetics — are particularly relevant for G allele carriers to mitigate.

Micronized purified flavonoid fractions (MPFF, e.g., diosmin-hesperidin combinations) have evidence from randomized trials for reducing venous edema and improving microcirculation in chronic venous disease. They act partly by reducing vascular permeability — a VEGFA-mediated mechanism — making them particularly relevant for VEGFA-pathway genotypes.

Interactions

The VEGFA locus interacts with other varicose vein risk loci identified in the same GWAS — including CASZ1 (vascular development), PIEZO1 (mechanosensitive ion channel), and extracellular matrix genes (ELN, LTBP3, COL3A1). Individuals carrying multiple risk alleles across these independent loci will have additive polygenic risk that compounds the modest VEGFA effect. The polygenic risk score derived in the Ahmed et al. 2022 cohort has predictive utility for varicose vein surgery, suggesting that cumulative genetic burden at VEGFA and these other loci has clinical prognostic value.

VEGFA also interacts with the coagulation cascade — elevated VEGFA increases vascular permeability that can promote local thrombus formation in venous stasis conditions. Carriers of thrombophilia variants (Factor V Leiden rs6025, Prothrombin rs1799963, MTHFR rs1801133) who also carry GG at rs11967262 may have compounded venous disease risk through convergent mechanisms.

Genotype Interpretations

What each possible genotype means for this variant.

CC Low Varicose Vein Risk Normal

Common genotype — no elevated VEGFA-pathway varicose vein risk

You carry two copies of the C allele at rs11967262, the most common genotype globally. About 34% of people worldwide share this genotype, with higher frequency in populations of European descent (approximately 27%). The C/C genotype is not associated with elevated varicose vein risk through the VEGFA pathway — your upstream VEGFA regulatory region does not carry the G allele that was associated with increased risk in the large 810,000-person varicose vein GWAS. Any varicose vein risk you carry comes from other genetic or lifestyle factors rather than this particular variant.

CG Moderate Varicose Vein Risk Intermediate

One G allele — modestly elevated varicose vein risk via VEGFA pathway

The CG genotype places you in the intermediate risk category for VEGFA-driven venous wall remodeling. With one G allele, your venous endothelial cells may produce somewhat higher VEGFA levels in response to hemodynamic stress than CC carriers. VEGFA's effects on vascular permeability and smooth muscle phenotype are dose-sensitive, so the heterozygous state is expected to produce intermediate effects on venous wall integrity.

The absolute risk elevation from one G allele is modest — roughly 9% relative increase over the CC baseline. For a condition affecting 25% of women and 15% of men in Western populations, this translates to a small absolute risk increment. However, this genetic risk is additive with occupational exposures, BMI, pregnancy, and other varicose vein risk factors that also upregulate VEGFA through hypoxic and inflammatory pathways.

GG Higher Varicose Vein Risk High Risk

Two G alleles — highest VEGFA-pathway varicose vein risk at this locus

GG homozygotes carry the maximum allelic load at this VEGFA locus for varicose vein risk. With two G alleles, venous endothelial and smooth muscle cells may chronically express higher levels of VEGFA in response to hemodynamic stressors — prolonged standing, venous hypertension, inflammation, or hypoxia. VEGFA increases vascular permeability by loosening endothelial tight junctions, allowing plasma proteins into the vessel wall, driving edema and inflammation. It also promotes smooth muscle cell switching from contractile to synthetic phenotype, reducing venous wall tone and structural integrity over time.

The OR of 1.09 per allele translates to approximately OR 1.19 for GG vs CC — a ~19% relative risk increase. Because varicose veins are very common (~25% lifetime risk in women), even an OR of 1.19 results in meaningful absolute risk elevation. GG carriers should treat this as a signal to aggressively manage all modifiable varicose vein risk factors — particularly prolonged lower-extremity venous stasis from occupational posture.

The VEGFA pathway also intersects with venous thromboembolism risk. A Mendelian randomization study found genetically elevated VEGF levels associate with increased VTE risk (OR 1.064 per SD increase). GG carriers with additional thrombophilia risk factors may face compounded venous disease burden beyond varicose veins alone.