Abdominal Aortic Aneurysm In Men Research Articles

Aortic aneurysms in a general population cohort: prevalence and risk factors in men and women.

The prevalence and difference in risk factors for having thoracic and abdominal aortic aneurysms in men compared to women in the general population is not well-described. This study aimed to test the hypotheses i) that cardiovascular risk factors for thoracic and abdominal aortic aneurysms differ and ii) that the prevalence of thoracic and abdominal aortic aneurysms is sex specific. Aortic examination using computed tomography angiography was performed in 11,294 individuals (56% women), with a mean age of 62 [range 40-95] years participating in the Copenhagen General Population Study. Thoracic aortic aneurysms were defined as ascending aortic diameter ≥45 mm and descending aortic diameter ≥35 mm, abdominal aortic aneurysms were defined as abdominal aortic diameter ≥30 mm. Demographic data were obtained from questionnaires. Overall prevalence of aortic aneurysms in the study population included: total population 2.1%, men 4.0% and women 0.7% (p-test men vs. women p<0.001). Aortic aneurysms were independently associated with male sex, increasing age, and body surface area. While thoracic aortic aneurysms were associated with hypertension, odds ratio=2.0[95%CI:1.5-2.8], abdominal aortic aneurysms were associated with hypercholesterolemia and smoking, odds ratios=2.4[95%CI:1.6-3.6] and 3.2[95%CI:1.9-5.4]. Subclinical aortic aneurysms are four times more prevalent in men than women. In both sexes, increasing age and body surface area are risk factors for aortic aneurysms of any anatomical location. Whereas arterial hypertension is a risk factor for thoracic aortic aneurysms, hypercholesterolemia and smoking are risk factors for abdominal aortic aneurysms.

The association between diabetes and abdominal aortic aneurysms in men: results of two Danish screening studies, a systematic review, and a meta-analysis of population-based screening studies

BackgroundA paradoxical protective effect of diabetes on the development and progression of abdominal aortic aneurysms (AAA) has been known for years. This study aimed to investigate whether the protective role of diabetes on AAAs has evolved over the years.MethodsA cross-sectional study, a systematic review and meta-analysis. This study was based on two large, population-based, randomised screening trials of men aged 65–74; VIVA (2008–2011) and DANCAVAS (2014–2018), including measurement of the abdominal aorta by ultrasound or CT, respectively. Analyses were performed using multiple logistic regressions to estimate the odds ratios (ORs) for AAAs in men with diabetes compared to those not having diabetes. Moreover, a systematic review and meta-analysis of population-based screening studies of AAAs to visualise a potential change of the association between diabetes and AAAs. Studies reporting only on women or Asian populations were excluded.ResultsIn VIVA, the prevalence of AAA was 3.3%, crude OR for AAA in men with diabetes 1.04 (95% confidence interval, CI, 0.80-1.34), and adjusted OR 0.64 (CI 0.48-0.84). In DANCAVAS, the prevalence of AAA was 4.2%, crude OR 1.44 (CI 1.11-1.87), and adjusted OR 0.78 (CI 0.59-1.04). Twenty-three studies were identified for the meta-analysis (N = 224 766). The overall crude OR was 0.90 (CI 0.77-1.05) before 2000 and 1.16 (CI 1.03-1.30) after 1999. The overall adjusted OR was 0.63 (CI 0.59-0.69) before 2000 and 0.69 (CI 0.57-0.84) after 1999.ConclusionBoth the crude and adjusted OR showed a statistically non-significant trend towards an increased risk of AAA by the presence of diabetes. If this represents an actual trend, it could be due to a change in the diabetes population.Trial registrationDANCAVAS: Current Controlled Trials: ISRCTN12157806. VIVA: ClinicalTrials.gov NCT00662480.

Low Progesterone and Low Estradiol Levels Associate With Abdominal Aortic Aneurysms in Men.

ContextMale sex is a major risk factor for abdominal aortic aneurysms (AAA) but few studies have addressed associations between sex hormone levels and AAA.ObjectiveWe aimed to describe the associations between serum sex steroids and early, screening-detected AAA in men.MethodsWe validated a high-sensitivity liquid chromatography–tandem mass spectrometry assay for comprehensive serum sex hormone profiling. This assay was then employed in a case-control study including 147 men with AAA (infrarenal aorta ≥ 30 mm) and 251 AAA-free controls recruited at the general population-based ultrasound screening for AAA in 65-year-old Swedish men.Outcomes includedassociations between dehydroepiandrosterone, progesterone, 17α-hydroxyprogesterone, androstenedione, estrone, testosterone, dihydrotestosterone, and estradiol and AAA presence.ResultsDehydroepiandrosterone, progesterone, 17α-hydroxyprogesterone, testosterone, and estradiol, but not the other hormones, were lower in men with AAA. In models with adjustments for known AAA risk factors and comorbidity, only progesterone (odds ratio per SD decrease 1.62 [95% CI, 1.18-2.22]) and estradiol (1.40 [95% CI, 1.04-1.87]) remained inversely associated with the presence of AAA. Progesterone and estradiol contributed with independent additive information for prediction of AAA presence; compared with men with high (above median) levels, men with low (below median) levels of both hormones had a 4-fold increased odds ratio for AAA (4.06 [95% CI, 2.25-7.31]).ConclusionMeasured by a high-performance sex steroid assay, progesterone and estradiol are inversely associated with AAA in men, independent of known risk factors. Future studies should explore whether progesterone and estradiol, which are important reproductive hormones in women, are protective in human AAA.

Preventing abdominal aortic aneurysm in men

Abdominal aortic aneurysm causes significant mortality and morbidity, particularly in older men. Primary prevention and early detection via screening with ultrasound are important interventions to reduce the high mortality rates.

Screening Older Adult Men for Abdominal Aortic Aneurysm: A Scoping Review.

Abdominal aortic aneurysm (AAA) is a potentially fatal condition predominantly affecting older adult men (60 years or over). Based on evidence, preventative health-care guidelines recommend screening older males for AAA using ultrasound. In attempts to reduce AAA mortality among men, screening has been utilized for early detection in some Western countries including the UK and Sweden. The current scoping review includes 19 empirical studies focusing on AAA screening in men. The findings from these studies highlight benefits and potential harms of male AAA screening. The benefits of AAA screening for men include decreased incidence of AAA rupture, decreased AAA mortality, increased effectiveness of elective AAA repair surgery, and cost-effectiveness. The potential harms of AAA screening included lack of AAA mortality reduction, negative impacts on quality of life, and inconsistent screening eligibility criteria being applied by primary care practitioners. The current scoping review findings are discussed to suggest changes to AAA screening guidelines and improve policy and practice.

Leukocyte subsets and abdominal aortic aneurysms detected by screening in men

In the present case-control study, we describe the associations between leukocyte subsets in blood and early, screening-detected AAA in men. An abdominal aortic aneurysm (AAA) may result in a life-threatening rupture of the aortic wall. The trigger for AAA formation remains unknown, but the vascular adventitia of advanced AAAs is infiltrated by various leukocytes, indicating that the pathogenesis may involve inflammation. In Sweden, all 65-year-old men are invited to an ultrasound examination for detection of AAA. At the Gothenburg screening site, 16256 men were examined in 2013-2017, 1.2% of whom had an AAA (diameter of the infrarenal aorta ≥30mm). All men with AAA at screening as well as a randomized selection of AAA-free screened men were invited to participate in a case-control study. The median diameter of AAAs was 33mm. Men with an AAA (n=151) had a higher frequency of smoking, hypertension and statin use than controls (n=224). Blood levels of neutrophils, lymphocytes, monocytes and basophils were higher in individuals with an AAA, but eosinophil count did not differ from controls. Odds ratios (95% confidence interval) for AAA were 8.6 (4.2-17.4), 3.5 (1.9-6.6) and 3.3 (1.8-6.3) for the highest versus lowest quartile of neutrophils, lymphocytes and monocytes, respectively. For neutrophils and lymphocytes, the association with AAA remained significant after adjustment for smoking and other known risk factors/markers. Several, but not all, subsets of circulating leukocytes are associated with screening-detected AAA in men, which is insufficiently explained by associations with smoking and other confounders.

Alcohol Intake and Growth Rate of Abdominal Aortic Aneurysms in Men- results of a Prospective Population-based Randomised Screening Trial with up to Five Year Follow-up

Introduction: Abdominal aortic aneurysm (AAA) is a common disease with a pathological dilatation of the aortic wall, and the prevalence is up to 2% people above 50 years. Age, smoking, male sex, family history of AAA, and hypertension are known risk factors for developing AAAs. Recent studies suggested that moderate intake of alcohol was associated with a lower hazard rate of developing AAA. No studies have reported how alcohol affects the growth rate of AAAs. Therefore, the aim of this study was to investigate the association between alcohol intake and growth rate of AAAs. Methods: This study was based on data from VIVA, a population-based randomised screening trial of men aged 65-74 enrolling from October 2008 until July 2011. Study participants were randomly assigned 1:1 to screening or no screening. Lifestyle parameters, medical history and use of medication were self-reported. Ultrasound scans of the infrarenal abdominal aorta were performed by specially trained nurses, the maximal systolic inner-to-inner anterior-posterior diameter was measured. Ultrasound surveillance was annual and continued up to five years. Results: Analysing the association between the aneurysmal growth rate and intake of alcohol, we found in our crude analysis that an increase by one daily unit of alcohol intake increased the growth rate by 3.5% (estimate 1.035, CI 0.99-1.08). After adjusting for potential confounders, we found that an increase by one daily unit of alcohol increased the aneurysmal growth rate by 2.3% (estimate 1.023, Cl 0.98-1.07). Analysing the need for repair as a time-to-event analysis, we found in our crude analysis, that an increase by one unit of alcohol changed the hazard ratio by 1.08 (CI 0.99-1.17). In our adjusted analysis, we found a similar result of one unit of alcohol increasing the hazard ratio by 1.07 (Cl 0.98-1.17). Conclusion: Although no statistically significant associations were exposed, a constant trend for adjusted positive associations between alcohol intake and the natural history of AAA was noticed calling for clarifying larger studies or meta-analyses. Disclosure: Nothing to disclose

Women With Abdominal Aortic Aneurysms Present a Different Pattern of Genetic Variability, Compared to Men

Introduction: Sex differences in abdominal aortic aneurysm (AAA) epidemiology have not been entirely explained. There are differences in exposure to the main risk factor smoking between men and women, but this can only partly explain the large difference in prevalence. The presence of familial predisposition suggests that genetic factors are also important for AAA development. We hypothesised that women who develop AAA may respond differently to female hormones, due to differences in their hormone receptors. Such genetic differences could explain why some women do develop AAA, despite generally being less susceptible to this disease. We also wanted to investigate if single nucleotide polymorphisms (SNPs) associated with AAA in men, also were associated with AAA in women. Thus, the aim was to investigate genetic variability in men and women with and without AAA. Methods: Peripheral blood from 97 female AAA patients, 103 female controls, 201 male AAA patients, and 201 male controls were analysed, quantifying variations in 21 SNPs associated with oestrogen receptors, extracellular matrix metabolism, LDL metabolism, vascular cell function and proliferation. Clinical data was collected using questionnaires. Association of SNPs to AAA was evaluated using PLINK 1.9 software testing for association using Fischer's exact test using dominant, recessive, allelic, genomic and Cohran-Armintage trend models for each SNP, adjusting the strongest associated models p-value using Monte Carlo permutations swapping case-labels. Adjusted p-values below 0.05 were considered significant. Results: Significant differences between AAA cases and controls were found in three SNPs: rs8113877 (14% vs. 27%, adjusted p-value 0.041) among women, and in rs2010963 (24% vs. 32%, adj. p-value 0.027) and rs4988300 (64% vs. 80%, adj. p-value 0.002) among men. SNP rs8113877 is located in the promotor of the MMP-9 gene and has been reported as elevating transcription activity of MMP-9 in vitro. We therefore analysed MMP-9 levels in peripheral blood in a subset of our main study population. MMP-9 levels were correlated to aneurysm disease and smoking status among both women and men but not to the rs8113877 genotype among neither women nor men. SNP rs2010963 in the VGEFA gene has previously been associated with AAA in a predominantly male cohort. VGEFA is a growth factor and part of the PDGF/VEGF family. VGEFA regulates proliferation and migration of endothelial cells and is involved in both physiological and pathological angiogenesis. SNP rs4988300 in located in the LRP5 gene which encodes a low-density lipoprotein receptor active in receptor-driven endocytosis. The level of lipoprotein(a) is reported as elevated among carriers. Lipoprotein(a) has been suggested as a biomarker for AAA in a meta-analysis performed 2017. Conclusion: Genetic variability associated with AAA differ between men and women. The potential importance of SNP rs8113877 for AAA development in women warrants further investigation. [Differences in pattern of genetic variability] Disclosure: Nothing to disclose

Visualizing and quantifying flow stasis in abdominal aortic aneurysms in men using 4D flow MRI

PurposeTo examine methods for visualizing and quantifying flow stasis in abdominal aortic aneurysms (AAA) using 4D Flow MRI. MethodsThree methods were investigated: conventional volumetric residence time (VRT), mean velocity analysis (MVA), and particle travel distance analysis (TDA). First, ideal 4D Flow MRI data was generated using numerical simulations and used as a platform to explore the effects of noise and background phase-offset errors, both of which are common 4D Flow MRI artifacts. Error-free results were compared to noise or offset affected results using linear regression. Subsequently, 4D Flow MRI data for thirteen (13) subjects with AAA was acquired and used to compare the stasis quantification methods against conventional flow visualization. ResultsVRT (R2 = 0.69) was more sensitive to noise than MVA (R2 = 0.98) and TDA (R2 = 0.99) at typical non-contrast signal-to-noise ratio levels (SNR = 20). VRT (R2 = 0.14) was more sensitive to background phase-offsets than MVA (R2 = 0.99) and TDA (R2 = 0.96) when considering a 95% effective background phase-offset correction. Qualitatively, TDA outperformed MVA (Wilcoxon p < 0.005, mean score improvement 1.6/5), and had good agreement (median score 4/5) with flow visualizations. ConclusionFlow stasis can be quantitatively assessed using 4D Flow MRI. While conventional residence time calculations fail due to error accumulation as a result of imperfect measured velocity fields, methods that do not require lengthy particle tracking perform better. MVA and TDA are less sensitive to measurement errors, and TDA generates results most similar to those obtained using conventional flow visualization.

Benefits and harms of screening men for abdominal aortic aneurysm in Sweden: a registry-based cohort study

Large reductions in the incidence of abdominal aortic aneurysm (AAA) and AAA-related mortality mean that results from randomised trials of screening for the disorder might be out-dated. The aim of this study was to estimate the effect of AAA screening in Sweden on disease-specific mortality, incidence, and surgery. Individual data on the incidence of AAA, AAA mortality, and surgery for AAA in a cohort of men aged 65 years who were invited to screening between 2006 and 2009, were compared with data from an age-matched contemporaneous cohort of men who were not invited for AAA screening. We also analysed national data for all men aged 40-99 years between Jan 1, 1987, and Dec 31, 2015, to explore background trends. Adjustment for confounding was done by weighting the analyses with a propensity score obtained from a logistic regression model on cohort year, marital status, educational level, income, and whether the patient already had an AAA diagnosis at baseline. Adjustment for differential attrition was also done by weighting the analyses with the inverse probability of still being in the cohort 6 years after screening. Generalised estimating equations were used to adjust the variance for repeated measurement and in response to the weighting. AAA mortality in Swedish men has decreased from 36 to ten deaths per 100 000 men aged 65-74 years between the early 2000s and 2015. Mortality decreased at similar rates in all Swedish counties, irrespective of whether AAA screening was offered. After 6 years with screening, we found a non-significant reduction in AAA mortality associated with screening (adjusted odds ratio [aOR] 0·76, 95% CI 0·38-1·51), which means that two men (95% CI -3 to 7) avoid death from AAA for every 10 000 men offered screening. Screening was associated with increased odds of AAA diagnosis (aOR 1·52, 95% CI 1·16-1·99; p=0·002) and an increased risk of elective surgery (aOR 1·59, 95% CI 1·20-2·10; p=0·001), such that for every 10 000 men offered screening, 49 men (95% CI 25-73) were likely to be overdiagnosed, 19 of whom (95% CI 1-37) had avoidable surgery that increased their risk of mortality and morbidity. AAA screening in Sweden did not contribute substantially to the large observed reductions in AAA mortality. The reductions were mostly caused by other factors, probably reduced smoking. The small benefit and substantially less favourable benefit-to-harm balance call the continued justification of the intervention into question. Research Unit and Section for General Practice, FoUU-centrum Fyrbodal, Sweden, and the region of Västra Götaland, Sweden.

Screening for Abdominal Aortic Aneurysm During Transthoracic Echocardiography: A Systematic Review and Meta-analysis

Screening for abdominal aortic aneurysm (AAA) during transthoracic echocardiography (TTE) may be an effective targeted screening strategy. The aim was to assess the feasibility of AAA screening during TTE and to estimate the prevalence of AAA in patients undergoing TTE. Electronic bibliographic sources were interrogated using a combination of free text and controlled vocabulary searches to identify studies reporting on AAA screening during TTE. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards. Fixed effect or random effects models were used to calculate pooled prevalence estimates. Twenty observational cohort studies were identified reporting a total of 43,341 participants (23,291 men and 20,050 women). Hypertension was reported in 41% (95% CI 38-43), hypercholesterolemia in 31% (95% CI 29-32), diabetes mellitus in 20% (95% CI 19-22), and tobacco use in 37% (95% CI 35-38). The aorta was visualised in 86% (95% CI 84-88) of the screened population. The pooled prevalence of AAA in the entire screened population was 0.033 (95% CI 0.024-0.044). The pooled prevalence of AAA in men was 0.046 (95% CI 0.032-0.065) and in women it was 0.014 (95% CI 0.008-0.022). The mean age of participants in whom an AAA was detected ranged across the studies from 66 to 85 years. The mean diameter of the aneurysm identified ranged across the studies from 35 mm to 45 mm. Clinical outcomes in participants with a detected AAA were poorly reported. Screening for AAA during TTE may identify a population group with a high risk of AAA in whom targeted screening may be beneficial. Further research is required to investigate the cost-effectiveness and clinical benefits of AAA screening in this setting.

Lifestyle and Risk of Screening-Detected Abdominal Aortic Aneurysm in Men.

BackgroundModifiable lifestyle‐related factors associated with risk of abdominal aortic aneurysm (AAA) are rarely investigated with a prospective design. We aimed to study possible associations among such factors and comorbidities with mean abdominal aortic diameter (AAD) and with risk of AAA among men screened for the disease.Methods and ResultsSelf‐reported lifestyle‐related exposures were assessed at baseline (January 1, 1998) among 14 249 men from the population‐based Cohort of Swedish Men, screened for AAA between 65 and 75 years of age (mean 13 years after baseline). Multivariable prediction of mean AAD was estimated with linear regression, and hazard ratios (HRs) of AAA (AAD ≥30 mm) with Cox proportional hazard regression. The AAA prevalence was 1.2% (n=168). Smoking, body mass index, and cardiovascular disease were associated with a larger mean AAD, whereas consumption of alcohol and diabetes mellitus were associated with a smaller mean AAD. The HR of AAA was increased among participants who were current smokers with ≥25 pack‐years smoked compared with never smokers (HR 15.59, 95% CI 8.96–27.15), those with a body mass index ≥25 versus <25 (HR 1.89, 95% CI, 1.22–2.93), and those with cardiovascular disease (HR 1.77, 95% CI, 1.13–2.77), and hypercholesterolemia (HR 1.59, 95% CI 1.08–2.34). Walking or bicycling for >40 minutes/day (versus almost never) was associated with lower AAA hazard (HR 0.59, 95% CI 0.36–0.97) compared with almost never walking or bicycling.ConclusionsThis prospective study confirms that modifiable lifestyle‐related factors are associated with AAD and with AAA disease.

Non-visualized aorta in abdominal aortic aneurysm screening: Screening outcomes and the influence of subject and programme characteristics.

Objectives To compare abdominal aortic aneurysm screening outcomes of men with non-visualized aorta at original scan with subsequent scans and to determine predictors of non-visualized aorta. Methods In the Northern Ireland Abdominal Aortic Aneurysm screening programme, outcomes (discharge, annual surveillance, three-monthly surveillance, or vascular referral) and patient and programme characteristics (age, deprivation quintile, family history, technician experience, and screening location) for men with non-visualized aorta were investigated at original scan, and first and second rescans. Results Non-visualized aorta proportions were 2.9, 11.4, and 4.7% at original, first, and second rescan, respectively. There were no differences in screening outcomes between scanning stages (98.4, 97.6, and 97.4% <3 cm). There were 42 men (0.13%) with aortas ≥5.5 cm at original scan, but none at first and second rescan. A significantly greater proportion with non-visualized aorta were from more deprived (5.0%) than less deprived areas (1.7%). Deprivation quintile and staff role were significant independent non-visualized aorta predictors at original scan, and staff role at first rescan. Men from less deprived areas were three times as likely to have aortas visualized than those from more deprived areas (OR = 3.0, CI = 2.4-3.8) at original scan. A man scanned by screening technician compared with lead sonographer was 51% less likely to have aorta visualized at original scan and 94% less likely at first rescan. Conclusions The risk of abdominal aortic aneurysm in men with non-visualized aorta on first or subsequent rescans is no more than for those with visualized aorta on original scanning. Men from deprived areas are much more likely to have non-visualized aorta at original scan.

Associations of Diabetes and Obesity with Risk of Abdominal Aortic Aneurysm in Men.

Background. The associations of diabetes and obesity with the risk of abdominal aortic aneurysm (AAA) are inconclusive in previous studies. Subjects/Methods. We conducted prospective analysis in the Physicians' Health Study. Among 25,554 male physicians aged ≥ 50 years who reported no AAA at baseline, 471 reported a newly diagnosed AAA during a mean of 10.4 years' follow-up. Results. Compared with men who had baseline body mass index (BMI) < 25 kg/m2, the multivariable hazard ratio (HR [95% CI]) of newly diagnosed AAA was 1.30 [1.06–1.59] for BMI 25–<30 kg/m2 and 1.69 [1.24–2.30] for BMI ≥ 30 kg/m2. The risk of diagnosed AAA was significantly higher by 6% with each unit increase in baseline BMI. This association was consistent regardless of the other known AAA risk factors and preexisting vascular diseases. Overall, baseline history of diabetes tended to be associated with a lower risk of diagnosed AAA (HR = 0.79 [0.57–1.11]); this association appeared to vary by follow-up time (HR = 1.56 and 0.63 during ≤ and >2 years' follow-up, resp.). Conclusion. In a large cohort of middle-aged and older men, obesity was associated with a higher risk, while history of diabetes tended to associate with a lower risk of diagnosed AAA, particularly over longer follow-up.

Revisiting the cost-effectiveness of screening 65-year-old men for abdominal aortic aneurysm based on data from an implemented screening programme.

Health economic analyses based on randomized trials have shown that screening for abdominal aortic aneurysm (AAA) cost-effectively decreases AAA-related, as well as all- cause mortality. However, follow-up from implemented screening programmes now reveal substantially changed conditions in terms of prevalence, attendance rate, costs and mortality after intervention. Our aim was to evaluate whether screening for AAA among 65-year-old men is cost-effective based on contemporary data on prevalence and attendance rates from an ongoing AAA screening programme. A decision-analytic model, previously used to analyse the cost-effectiveness of an AAA screening programme prior to implementation in clinical practice, was updated using data collected from an implemented screening programme as well as data from contemporary published data and the Swedish register for vascular surgery (Swedvasc). The base-case analysis showed that the cost per life-year gained and quality-adjusted life year (QALY) gained were €4832 and €6325, respectively. Based on conventional threshold values of cost-effectiveness, the probability of screening being cost-effective was high. Despite the reduction of AAA-prevalence and changes in AAA-management over time, screening 65-year-old men for AAA still appears to yield health outcomes at a cost below conventional thresholds of cost-effectiveness.

Differential expression of sex hormone receptors in abdominal aortic aneurysms

ObjectiveMale sex is a significant risk factor for abdominal aortic aneurysm (AAA). Female sex hormones have been reported to prevent aneurysm formation in animal models. The study aims to describe the expression profile of sex hormone receptors in the aneurysm wall of men and women with AAA and compare with unaffected controls. MethodsAneurysm wall biopsies were obtained during elective open repair of AAA in men and women (n=16+16). Aortic vessel wall from controls were obtained at organ donation (n=6). Western blot-, mRNA expression- and immunohistochemical analyses were performed to assess the expression profile of the sex hormone receptors – androgen receptor (AR), progesterone receptor (PR), estrogen receptor α (ERα) and β (ERβ). ResultsThe mRNA- and protein expression levels of AR were higher in AAA compared with control aorta (7.26 vs. 5.14, P=0.001). mRNA- and protein expression levels of ERβ were lower in AAA compared with control aorta (9.15 vs. 12.29, P<0.001). mRNA expression levels of PR were higher in AAA compared with control aorta (8.73 vs. 6.21, P=0.003), but could not be confirmed on protein level. The expression profile of sex hormone receptors in men and women with AAA was similar. ConclusionExpression of sex hormone receptors differs in the aneurysmal aorta compared with unaffected aorta in men and women. A higher expression of AR and a lower expression of ERβ suggest that sex hormone activity could be associated with aneurysm development.

Update on the prevention of death from ruptured abdominal aortic aneurysm.

Objectives To monitor the early effect of a national population screening programme for abdominal aortic aneurysm in 65-year-old men. Setting The study used national statistics for death rates from abdominal aortic aneurysm (Office of National Statistics) and hospital admission data in England (Hospital Episode Statistics). Methods Information concerning deaths from abdominal aortic aneurysm (ruptured and non-ruptured) (1999-2014) and hospital admissions for ruptured abdominal aortic aneurysm (2000-2015) was examined. Results The absolute number of deaths from abdominal aortic aneurysm in men and women aged 65 and over has decreased by around 30% from 2001 to 2014, but as the population has increased, the relative reduction was 45.6% and 40.0%, respectively. Some 65% of all abdominal aortic aneurysm deaths are in men aged over 65; women aged 65 and over account for around 31%. Deaths from ruptured abdominal aortic aneurysm in men aged 60-74 (the screened group) appear to be declining at the same rate as in men aged 75 and over. The relative decline in admissions to hospital with ruptured abdominal aortic aneurysm may be greater in men and women aged 60-74 (which contains the screened group of men), than those older, giving the first possible evidence that abdominal aortic aneurysm screening is having an effect. Conclusion The death rate from abdominal aortic aneurysm is declining rapidly in England. There is the first evidence that screening may be contributing to this reduction.

Outcome of the Swedish Nationwide Abdominal Aortic Aneurysm Screening Program.

A general abdominal aortic aneurysm (AAA) screening program, targeting 65-year-old men, has gradually been introduced in Sweden since 2006 and reached nationwide coverage in 2015. The aim of this study was to determine the outcome of this program. Data on the number of invited and examined men, screening-detected AAAs, AAAs operated on, and surgical outcome were retrieved from all 21 Swedish counties for the years 2006 through 2014. AAA-specific mortality data were retrieved from the Swedish Cause of Death Registry. A linear regression analysis was used to estimate the effect on AAA-specific mortality among all men ≥65 years of age for the observed time period. The long-term effects were projected by using a validated Markov model. Of 302 957 men aged 65 years invited, 84% attended. The prevalence of screening-detected AAA was 1.5%. After a mean of 4.5 years, 29% of patients with AAA had been operated on, with a 30-day mortality rate of 0.9% (1.3% after open repair and 0.3% after endovascular repair, P<0.001). The introduction of screening was associated with a significant reduction in AAA-specific mortality (mean, 4.0% per year of screening, P=0.020). The number needed to screen and the number needed to operate on to prevent 1 premature death were 667 and 1.5, respectively. With a total population of 9.5 million, the Swedish national AAA-screening program was predicted to annually prevent 90 premature deaths from AAA and to gain 577 quality-adjusted life-years. The incremental cost-efficiency ratio was estimated to be €7770 per quality-adjusted life-years. Screening 65-year-old men for AAA is an effective preventive health measure and is highly cost-effective in a contemporary setting. These findings confirm the results from earlier randomized controlled trials and model studies in a large population-based setting of the importance for future healthcare decision making.

Ultrasound Screening of Men with Coronary Artery Disease for Abdominal Aortic Aneurysms: A Prospective Dual Center Study.

According to the heterogeneous results of previous studies, the prevalence of abdominal aortic aneurysm seems high among men with coronary artery disease. The associating risk factors for abdominal aortic aneurysm in this population require clarification. Our objective was to assess the prevalence of non-diagnosed abdominal aortic aneurysms in men with angiographically verified coronary artery disease and to document the associated co-morbidities and risk factors. Altogether, 407 men with coronary artery disease were screened after invasive coronary angiography in two series at independent centers. Risk factor data were recorded and analyzed. The mean age of the study cohort was 70.0 years (standard deviation: 11.0). The prevalence of previously undiagnosed abdominal aortic aneurysms in the whole screened population of 407 men was 6.1% (n = 25/407). In a multivariate analysis of the whole study population, the only significant risk factors for abdominal aortic aneurysm were age (odds ratio: 1.04, 95% confidence interval: 1.00-1.09) and history of smoking (odds ratio: 3.13, 95% confidence interval: 1.26-7.80). Non-smokers with abdominal aortic aneurysm were significantly older than smokers (mean age: 80.7 (standard deviation: 8.0) vs 68.0 (standard deviation: 11.1), p = 0.003), and age was a significant risk factor only among non-smokers (p = 0.011; p = 0.018 for interaction). Among smokers, the prevalence of abdominal aortic aneurysm was 8.8%, and 72% (n = 18/25) of all diagnosed abdominal aortic aneurysm patients were smokers. Prevalence of undiagnosed abdominal aortic aneurysms among patients with coronary artery disease is high, and history of smoking is the most significant risk factor for abdominal aortic aneurysm. Effectiveness of selective screening of abdominal aortic aneurysm in male patients with coronary artery disease warrants further studies.

Prevalence of Abdominal Aortic Aneurysm in Men Aged 65–74 Years in a Metropolitan Area in North-East Spain

A declining prevalence of AAA and a shift in the distribution towards the older population have been observed during the last decade in Europe. The aim was to estimate the current screening prevalence of AAA in men aged 65-74 years in a metropolitan area in north-east Spain and to identify associated risk factors. A cross sectional prevalence study in men registered in L'Hospitalet Primary Healthcare Services (Barcelona, Spain) was performed. There were 619 randomly selected subjects (expected prevalence of aneurysm, 5%; accuracy of estimation, ±2%; loss to follow up, 30%). Exclusion criteria were life expectancy <1 year, limited quality of life, previous diagnosis of AAA, prior aorto-femoral surgery, and non-Caucasian. The following were measured: internal diameter of the infrarenal abdominal aorta using ultrasound, cardiovascular risk factors, personal (heart disease, stroke, peripheral vascular disease) and family history (AAA), physical examination, and blood tests. We estimated the prevalence and 95% confidence interval of AAA, and used logistic regression analysis to identify risk factors for AAA. Among the 651 individuals included in the analysis the prevalence of aneurysm was 2.30% (95% CI, 1.30-3.77%). In the regression analysis, AAA was associated with smoking (0-10, 11-20, or >20 cigarettes/day), diagnosis of myocardial infarction, and being taller than the median (165cm). The current screening prevalence of AAA among men aged 65-74 years in a metropolitan area in north-east Spain is similar to that in northern Europe. Smoking, myocardial infarction, and height were associated with the presence of AAA.