In the literature, the estimates of high risk of family history for varicose veins are based on prevalence rates from cross-sectional studies. The purpose of this study was to compare such prevalence rates with incidence rates from our longitudinal follow-up study to find out whether there is a difference due to the methodology. A validated questionnaire was used in 3 middle-aged cohorts (n = 6874) in Tampere, Finland. Positive family history was more common both in men (prevalence odds ratio 6.6; 95% confidence interval, 4.7-9.3) and women (4.9; 95% confidence interval, 4.0-6.0) with varicose veins compared to those without. However, positive family history was linked much less with the incidence of varicose veins than the prevalence of varicose veins in women (incidence odds ratio 1.8; 95% confidence interval, 1.1-2.8) and men 1.4 (95% confidence interval, 0.7-2.6). There is likely to be a hereditary component of varicose veins, but it is substantially less than usually proposed in literature.