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Abstract
Several studies have found that smoking increases the risk of abdominal aortic aneurysm, however, the strength of the association has differed between studies and data from cohort studies have not yet been summarized. A systematic review and meta-analysis was therefore conducted to clarify this association. We searched PubMed and Embase databases up to May 2nd 2018. A random effects model was used to estimate summary relative risks (RRs) and 95% confidence intervals (CIs). Twenty three prospective studies were included. Comparing current, former and ever smokers with never smokers the summary RRs were 4.87 (95% CI: 3.93–6.02, I2 = 92%, n = 20), 2.10 (95% CI: 1.76–2.50, I2 = 71%, n = 15) and 3.28 (95% CI: 2.60–4.15, I2 = 96%, n = 18), respectively. The summary RR was 1.87 (95% CI: 1.45–2.40, I2 = 97%) per 10 cigarettes per day, 1.78 (95% CI: 1.54–2.06, I2 = 83%) per 10 pack-years was and 0.45 (95% CI: 0.32–0.63, I2 = 92.3%) per 10 years of smoking cessation. There was evidence of nonlinearity for cigarettes per day and pack-years (pnonlinearity < 0.0001 and pnonlinearity = 0.02, respectively), but not for smoking cessation, pnonlinearity = 0.85. Among smokers who quit, the RR was similar to that of never smokers by 25 years of smoking cessation. These findings confirm a strong association between smoking and the risk of developing abdominal aortic aneurysms.
Highlights
Several studies have found that smoking increases the risk of abdominal aortic aneurysm, the strength of the association has differed between studies and data from cohort studies have not yet been summarized
Twenty studies (18 publications)[7,16,18,19,22,23,25,26,27,28,29,30,31,32,33,34,35,36] of current smokers (8901 cases, 4716185 participants), fifteen studies[7,19,22,23,25,26,27,29,30,31,33,35,36] of former smokers (7824 cases, 3060503 participants), and eighteen studies (16 publications)[7,16,17,19,22,23,25,26,27,29,30,32,33,34,35,36] of ever smokers (8448 cases, 3934635 participants) and abdominal aortic aneurysms were included in the analyses
The summary relative risks (RRs) for current smokers vs. never smokers was 4.87 (Fig. 2A), for former smokers it was 2.10 (Fig. 2B), and for ever smokers it was 3.28 (Fig. 2C)
Summary
Several studies have found that smoking increases the risk of abdominal aortic aneurysm, the strength of the association has differed between studies and data from cohort studies have not yet been summarized. The RR was similar to that of never smokers by 25 years of smoking cessation These findings confirm a strong association between smoking and the risk of developing abdominal aortic aneurysms. A previous meta-analysis found an increased risk of abdominal aortic aneurysms among smokers, only screening studies (cross-sectional studies) were included in that analysis[37]. As cross-sectional studies cannot be used to draw causal inferences we conducted a systematic review and meta-analysis of prospective studies on the association between tobacco smoking and the risk of abdominal aortic aneurysms to provide better evidence from studies with a stronger study design. We aimed to clarify the strength and shape of the dose-response relationship between tobacco smoking and risk of abdominal aortic aneurysm, potential differences of the association by sex, and the effects of smoking cessation
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