Abstract
Cancers and abdominal aortic aneurysms (AAA) cause substantial morbidity and mortality and commonly develop in old age. It has been previously reported that AAA patients have a high prevalence of cancers, which has raised the question of whether this is a simple collision, association or causation. Clinical trials or observational studies with sufficient power to prove this association between them were limited because of the relatively low frequency and slow disease process of both diseases. We aimed to determine whether there is a significant association between AAA and cancers using nationwide data. The patients aged > 50 years and diagnosed with AAA between 2002 and 2015, patients with heart failure (HF) and controls without an AAA or HF matched by age, sex and cardiovascular risk factors were enrolled from the national sample cohort from the National Health Insurance claims database of South Korea. The primary outcome was the prevalence rate of cancers in the participants with and without an AAA. The secondary outcome was cancer-related survival and cancer risk. Overall, 823 AAA patients (mean (standard deviation) age, 71.8 (9.4) years; 552 (67.1%) men) and matching 823 HF patients and 823 controls were identified. The prevalence of cancers was 45.2% (372/823), 41.7% (343/823) and 35.7% (294/823) in the AAA, HF and control groups, respectively; it was significantly higher in the AAA group than in the control group (p < 0.001). The risk of developing cancer was higher in the AAA patients than in the controls (adjusted odds ratio (OR), 1.52 (95% confidence interval [CI], 1.24–1.86), p < 0.001) and in the HF patients (adjusted OR, 1.37 (1.24–1.86), p = 0.006). The cancer-related death rate was 2.64 times higher (95% CI, 2.22–3.13; p < 0.001) for the AAA patients and 1.63 times higher (95% CI, 1.37–1.92; p < 0.001) for the HF patients than for the controls. The most common causes of death in the AAA patients were cancer and cardiovascular disease. There was a significantly increased risk of cancer in the AAA than in the HF and control groups. Therefore, appropriate screening algorithms might be necessary for earlier detection of both diseases to improve long-term survival.
Highlights
We aimed to investigate the prevalence of concomitant abdominal aortic aneurysms (AAA) and cancer in a national sample cohort from the South
Among the 1,108,369 subjects of the NHIS-national sample cohort (NSC) database, we identified 899 patients with AAA, 76 of whom were excluded from the analysis according to the aforementioned out of 52 patients (67.3%) were not AAA patients
Among the 1,108,369 subjects of the NHIS-NSC database, we identified 899 patients with AAA, 76 of whom were excluded from the analysis according to the aforementioned criteria
Summary
An abdominal aortic aneurysm (AAA) is characterized by a chronic inflammatory component with a degenerative component. Its origin is a multifactorial disease related to both genetic and environmental risk factors [1]. Smoking is considered one of the most important risk factors for AAA [2]. While the prevalence of AAA is negligible before the age of 65 years, it increases steadily with age thereafter, estimated to range between 1% and 2% in men and around 0.5% in women aged ≥ 65 years [3]. AAAs cause 1.3% of all deaths among men aged 65–85 years in developed countries [3]
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