Abdominal Aortic Aneurysm

Abstract

Most manifestations of cardiovascular disease are more common in men than in women. However, cardiovascular disease is the most common cause of death in women worldwide.1 Coronary heart disease in women has a worse outcome than in men, and this has attracted considerable attention in recent years, with calls for more gender-specific research.1,2 Abdominal aortic aneurysms (AAAs) also are less common in women than in men, and, as with coronary heart disease, there is evidence that women with AAA also have a worse prognosis. The present review addresses the epidemiology, development, natural history, management, and outcomes of AAA in women. When the definition of a maximum external diameter ≥3 cm is used, the prevalence of AAA is up to 6 times greater in men than in women.3,4 In a community-based screening study of the older population, the prevalence of AAA was 1.3% in women compared with 7.6% in men.4 Similarly, the ratio of men to women in surgical series is ≈5:1.5–7 Because of the relatively low prevalence, women were excluded from the large trials of screening for AAA.8–10 The prevalence in women from families with a strong history of AAA may be as high as 8.3%, and these women should be offered screening.11 Modeling studies have indicated that screening for AAA in women could be cost-effective because the rupture rate appears to be much higher in women than in men.12 The incidence of AAA has continued to rise over the last 4 decades.13–16 Initially, a similar pattern was seen in both genders, although the increase in mortality and admission rate has been become more marked in women.15,16 Inspection of data derived from national (England and Wales) statistics shows that the annual number of hospital admissions for aneurysm rupture between 1997 …