Family History Of Abdominal Aortic Aneurysm Research Articles

A prospective longitudinal study of risk factors for abdominal aortic aneurysm.

The aim of this study was to identify risk factors for abdominal aortic aneurysm (AAA)from the largest Welsh screening cohort to date. Patients were recruited from 1993 (to 2015) as part of the South East Wales AAA screening programme through general practitioners. Demographic data and risk factors were collected by means of a self-report questionnaire. Statistical tests were performed to determine whether associations could be observed between AAA and potential risk factors. Odds ratios (OR) were also calculated for each of the risk factors identified. A total of 6879 patients were included in the study. Two hundred and seventy-five patients (4.0%) presented with AAA, of which 16% were female and 84% were male. Patients with AAA were older than the (no AAA) control group (p < 0.0001). The following risk factors were identified for AAA: family history of AAA (p < 0.0001); history of vascular surgery (p < 0.0001), cerebrovascular accident (p < 0.0001), coronary heart disease (p < 0.0001), diabetes (p < 0.0001), medication (p = 0.0018), claudication (p < 0.0001), smoking history (p = 0.0001) and chronic obstructive pulmonary disorder (p = 0.0007). AAA is associated with classical vascular risk factors, in addition to other less-well-documented risk factors including previous vascular surgery. These findings have practical implications with the potential to improve future clinical screening of patients in order to reduce AAA mortality.

The role of diabetes on the development of abdominal aortic aneurysms (AAA)

An abdominal aortic aneurysm (AAA) is a pathological local dilatation of the abdominal aorta that may develop from a variety of causes. With a 80% mortality rate, it is mainly linked to male gender, age above 65 years, smoking, and a family history of AAA. Ultrasonography is an effective method for screening males who are 65 or older for AAA. Endovascular aneurysm repair (EVAR) procedure reduces 30-day operative mortality and hospital stay, becoming a global standard. Both open and endovascular surgery aim to cut off the aneurysm's circulation, preventing it from rupturing. Diabetes mellitus (DM) may provide protection against regrowth and the need for additional intervention after endovascular AAA repair, thereby limiting the enlargement and rupture of AAAs. Hyperglycemia thickens the aortic walls and reduces wall stress in diabetic patients' abdominal aortas. It stabilizes collagen structure and promotes the synthesis of collagen type IV. Anti-diabetic drugs like metformin, thiazolidinedione, and dipeptidyl peptidase 4 inhibitors (DPP-4i) have been shown in both animal and human studies to protect against aortic aneurysms. In a dose-response pattern, these antidiabetic drugs may lower the prevalence, incidence, and enlargement rate of AAA.

Evaluating growth patterns of abdominal aortic aneurysms among women

ObjectiveThough initially protected from vessel dilation by estrogen, women may experience rapid abdominal aortic aneurysm (AAA) growth post-menopause. The rate of growth has been poorly defined in prior literature. Here, we describe aneurysm growth in a cohort of women found through an AAA screening program. MethodsWomen with AAAs were retrospectively identified. Aortic imaging was reviewed, and measurements of maximum transverse and anterior-posterior diameters were completed. Growth was stratified by the type of aortic pathology (fusiform aneurysm, aortic ectasia, dissection with aneurysmal degeneration, saccular aneurysm) as well as size category (<3 cm, 3.0-3.9 cm, 4.0-4.9 cm, ≥5.0 cm) at diagnosis. ResultsA cohort of 488 women was identified; 286 had multiple scans for review. The mean age of the entire cohort was 75 ± 9.9 years. Stratified by type of pathology, the mean age was 76 ± 8.9 years in patients with a fusiform AAA, 74 ± 9.8 years in ectasia, 65 ± 13.7 years in dissection, and 76 ± 5.6 years in saccular aneurysms. The maximum growth was highest in women with fusiform AAAs, followed by dissection, ectasia, and saccular pathology (9.7 mm, 7.0 mm, 3.0 mm, and 2.2 mm, respectively; P < .001). Comparing mean growth by year, the highest mean growth was in fusiform AAAs (3.6 mm vs 1.75 mm in dissection; P < .001). The Shapiro-Wilk test demonstrated that mean growth per year was non-normally distributed with a right skew. Stratified by aortic diameter at the time of diagnosis, mean growth/year increased with increasing size at diagnosis in fusiform AAAs and dissection (0.91 mm for <3 cm, 2.34 mm for 3.0-3.9 cm, 2.49 mm for 4.0-4.9 mm, and 6.16 mm for ≥5.0 cm in patients with fusiform AAAs vs 0.57 mm, 0.94 mm, 1.87 mm, and 2.66 mm, respectively, for patients with dissection). Smoking history was associated with a higher mean growth/year (2.6 mm vs 3.3 mm; P < .001). Conversely, patients with a family history of AAA had a lower mean growth/year (3.2 mm vs 1.5 mm; P < .001). ConclusionsThe rate of aneurysm growth in women varies based on pathology and aneurysm size, and women experience rapid aneurysm growth at sizes greater than 4.5 cm. Current screening guidelines are inadequate, and our results demonstrate that the rate of growth of fusiform aneurysms in women is faster than in men at a smaller size and may warrant more frequent surveillance than current Society for Vascular Surgery recommendations to prevent risk of increased morbidity.

Screening Men and Women above the Age of 50 Years for Abdominal Aortic Aneurysm: A Pilot Study in an Upper Middle Income Country

Screening for abdominal aortic aneurysm (AAA) is recommended in high risk populations based on local conditions. Differences in lifestyle and risk factors between countries with different income status make risk stratification based on geographic location necessary. The majority of epidemiological studies on AAA have reported data from high income countries. The aim of this study was to explore the prevalence and risk factors for AAA in an upper middle income country in Eastern Europe. A pilot screening project for AAA, supported by a mass media campaign, was conducted in 2023 in seven cities in Serbia. Ultrasound evaluation of the abdominal aorta was performed by a registered vascular surgeon on individuals who agreed to participate. Participants who attended screening completed a questionnaire on demographic and clinical information. To assess risk factors for AAA, univariable logistic regression analysis was performed to compute the odds ratio (OR) with 95% confidence interval (CI). Multivariable logistic regression was subsequently performed with adjustments for sex, age, family history of AAA, and other relevant factors. A total of 4 046 participants (51.2% male and 48.8% female; mean age 68.8 ± 7.6 years) responded to the campaign. An aneurysm was found in 195 (4.8%) screened individuals (8.2% of men and 1.3% of women). In males aged 50 - 64 years, the prevalence of AAA was 5.4%. Male sex, older age, family history of AAA, being a smoker or ex-smoker, being overweight, and alcohol consumption were predictors of AAA in the univariable analysis. After adjustments in the multivariable analysis, male sex (OR 8.04, 95% CI 4.87 - 13.28), older age (OR 1.04, 95% CI 1.02 - 1.07), positive family history (OR 2.47, 95% CI 1.61 - 3.78), smoker status (OR 3.10, 95% CI 2.10 - 4.59), ex-smoker status (OR 2.13, 95% CI 1.39 - 3.27), and being overweight (OR 1.85, 95% CI 1.25 - 2.74) were independent risk factors for AAA. The prevalence of AAA has not been reduced in all countries, and screening strategies might be changed based on local epidemiological data. The results of this pilot study underline the importance of exploring the prevalence of AAA in populations with a high prevalence of smoking.

Machine learning-based prediction of abdominal aortic aneurysms for individualized patient care

ObjectiveThe United States Preventative Services Task Force guidelines for screening for abdominal aortic aneurysms (AAA) are broad and exclude many at risk groups. We analyzed a large AAA screening database to examine the utility of a novel machine learning (ML) model for predicting individual risk of AAA. MethodsWe created a ML model to predict the presence of AAAs (>3 cm) from the database of a national nonprofit screening organization (AAAneurysm Outreach). Participants self-reported demographics and comorbidities. The model is a two-layered feed-forward shallow network. The ML model then generated AAA probability based on patient characteristics. We evaluated graphs to determine significant factors, and then compared those graphs with a traditional logistic regression model. ResultsWe analyzed a cohort of 10,033 patients with an AAA prevalence of 2.74%. Consistent with logistic regression analysis, the ML model identified the following predictors of AAA: Caucasian race, male gender, advancing age, and recent or past smoker with recent smoker having a more profound affect (P < .05). Interestingly, the ML model showed body mass index (BMI) was associated with likelihood of AAAs, especially for younger females. The ML model also identified a higher than predicted risk of AAA in several groups, including female nonsmokers with cardiac disease, female diabetics, those with a family history of AAA, and those with hypertension or hyperlipidemia at older ages. An elevated BMI conveyed a higher than expected risk in male smokers and all females. The ML model also identified a complex relationship of both diabetes mellitus and hyperlipidemia with gender. Family history of AAA was a more important risk factor in the ML model for both men and women too. ConclusionsWe successfully developed an ML model based on an AAA screening database that unveils a complex relationship between AAA prevalence and many risk factors, including BMI. The model also highlights the need to expand AAA screening efforts in women. Using ML models in the clinical setting has the potential to deliver precise, individualized screening recommendations.

Association of Genetic Polymorphisms with Abdominal Aortic Aneurysm in the Processes of Apoptosis, Inflammation, and Cholesterol Metabolism.

Background and Objectives: This study aims to identify the minor allele of the single nucleotide polymorphisms (SNPs) DAB2IP rs7025486, IL6R rs2228145, CDKN2BAS rs10757278, LPA rs3798220, LRP1 rs1466535, and SORT1 rs599839 in order to assess the risk of abdominal aortic aneurysm (AAA) formation and define the linkage among these SNPs. Materials and Methods: A case-control study with AAA patients (AAA group) and non-AAA controls (control group) was carried out in a study population. DNA was isolated from whole blood samples; the SNPs were amplified using PCR and sequenced. Results: In the AAA group of 148 patients, 87.2% of the patients were male, 64.2% had a history of smoking, and 18.2% had relatives with AAA. The mean ± SD of age, BMI, and aneurysmal diameter in the AAA group were 74.8 ± 8.3 years, 27.6 ± 4.6 kg/m2, and 56.2 ± 11.8 mm, respectively. In comparison with 50 non-AAA patients, there was a significantly elevated presence of the SNPs DAB2IP rs7025486[A], CDKN2BAS rs10757278[G], and SORT1 rs599839[G] in the AAA group (p-values 0.040, 0.024, 0.035, respectively), while LPA rs3798220[C] was significantly higher in the control group (p = 0.049). A haplotype investigation showed that the SNPs DAB2IP, CDKN2BAS, and IL6R rs2228145[C] were significantly elevated in the AAA group (p = 0.037, 0.037, and 0.046) with minor allele frequencies (MAF) of 25.5%, 10.6%, and 15.4%, respectively. Only DAB2IP and CDKN2BAS showed significantly higher occurrences of a mutation (p = 0.028 and 0.047). Except for LPA, all SNPs were associated with a large aortic diameter in AAA (p < 0.001). Linkage disequilibrium detection showed that LPA to DAB2IP, to IL6R, to CDKN2BAS, and to LRP1 rs1466535[T] had D' values of 70.9%, 80.4%, 100%, and 100%, respectively. IL6R to LRP1 and to SORT1 had values for the coefficient of determination (r2) of 3.9% and 2.2%, respectively. Conclusions: In the investigated study population, the SNPs CDKN2BAS rs10757278, LPA rs3798220, SORT1 rs599839, DAB2IP rs7025486, and IL6R rs2228145 were associated with the development of abdominal aortic aneurysms. Individuals with risk factors for atherosclerosis and/or a family history of AAA should be evaluated using genetic analysis.

Abdominal Aortic Aneurysm: Natural History, Pathophysiology and Translational Perspectives.

An abdominal aortic aneurysm (AAA) is a degenerative pathology that affects the infrarenal segment of the aorta, leading to its progressive dilatation and eventually rupture. The infrarenal segment is involved in 80% of the aortic aneurisms, and represents alone 30% of all aneurysms. The natural history of the disease is characterized by the progressive increase of the aortic diameter associated with proportionally higher risk of rupture, particularly for cases with diameter greater than 5.5 cm. In case of rupture the mortality rate is very high, independently from the endovascular or surgical treatment. The most important risk factors are older age, smoking, hypertension, dyslipidemia, and family history of AAA. The most frequent form is "atherosclerotic", but infectious, collagen disease-related, immune dysregulation-related, and post-traumatic AAA have also been described. Albeit multiple pathogenetic hypotheses have been proposed, the role of metallo-proteinases in the degeneration of the aortic wall seem to play a central role. Early detection of AAA is crucial for the identification and treatment before the onset of potentially life-threatening complications. Moreover, the individual risk stratification is fundamental for the clinical management and follow-up. The growing knowledge about the pathophysiology of AAA has the potential to lead to significant translational advances. The challenge for the next years is to employ bioinformatic and genetic models, also based on artificial intelligence and machine learning approach, to develop novel screening methods and to stratify individuals at higher-risk or in the early stages of AAA.

Normal Infrarenal Aortic Diameter in Men and Women in a Mediterranean Area

Infrarenal aortic diameter (AD) values currently considered normal are based on measurements from epidemiologic studies performed over 20years ago. Knowledge of expected normal AD is important for understanding the relevance of abdominal aortic dilatation. The aim of this study was to define contemporary reference values for normal infrarenal AD and build a predictive model based on individual features. A cross-sectional study of participants in a population-based screening program for abdominal aortic aneurysm (AAA) was performed in a healthcare district with 400,000 inhabitants. Men and women aged 65years were invited to participate. Cardiovascular (CV) risk factors, family history of AAA, personal history of other aneurysms, CV disease, and anthropometric parameters were evaluated. The largest anteroposterior inner-inner diameter of the infrarenal aorta was measured by ultrasound. Multiple linear regressions were used to determine independent predictors of AD. The best-fit model was obtained by randomly selecting 70% of the sample and validating the results in the remaining 30%. A total of 4,730 people (2,089 men and 2,641 women) were invited. The participation rate was 50.4% for men and 44.0% for women. Mean AD (standard deviation, SD)was 16.51 (3.2) mm in the overall group, 17.91 (3.51) mm in men, and 15.25 (2.32) mm in women (P<0.001). Male sex (P<0.001), body surface area (P<0.001), smoking habit (P=0.012), and history of arterial aneurysms (P=0.013) were independently associated with increased AD. Dyslipidemia was associated with decreased AD (P<0.001). The findings were used to build a model for predicting AD based on individual characteristics. ADs in our study population are smaller than those described in classic epidemiological studies. Men have a significantly larger diameter than women and the strongest predictor of increased AD is body surface area. A greater understanding of factors associated with AD will help predict expected sizes in individual members of the population.

Treatment of recurrent iliac branch occlusion after endovascular repair of abdominal aortic aneurysm diagnosed by contrast- enhanced ultrasound combined with computed tomography angiography: a case report

Endovascular treatment of abdominal aortic aneurysm (AAA) has been in use for several decades and has become the main treatment for this disease. Iliac branch occlusion (IBO) is a common complication after endovascular treatment. The diagnosis and guidance of contrast-enhanced ultrasound (CEUS) combined with computed tomography angiography (CTA) in the treatment of recurrent IBO after endovascular aneurysm repair (EVAR) are rarely reported. In this case, CEUS gave important hints on the cause of IBO. We present a 67-year-old male patient who was diagnosed with AAA in 2020 and underwent endovascular treatment in the same period. There was no family history of AAA. The operation process was successful. The CTA re-examination one month after operation showed that the aneurysm was well isolated without obvious endoleak. However, the patient developed intermittent claudication of both lower limbs after operation, but did not receive relevant diagnosis and treatment. Four months after surgery, the patient's claudication symptoms of the left lower limb were significantly worse than before, and CTA review revealed left IBO. The left ankle brachial index (ABI) was too low to detect the value. A femoral artery thrombectomy was performed and a stent was extended distal to the left iliac stent. The claudication symptoms improved after surgery. Unfortunately, only two months later, the patient developed rest pain in the left lower limb. CTA examination showed that the left iliac branch was occluded again. The problem in the proximal end of the left iliac branch was observed by CEUS before re-operation, which was also confirmed by digital subtraction angiography (DSA) after thrombectomy. The blood flow was significantly improved after the angle of the proximal iliac branch was adjusted by stent placement. The patient did not show claudication symptoms again during follow-up. Through CEUS, we identified the pathogenic causes which could not be reflected in CTA and formulated the correct treatment plan. The risk factors of IBO after EVAR are mostly hidden in the process of the initial operation. CEUS can provide more information about postoperative hemodynamics than CTA. The role of CEUS in postoperative follow-up of endovascular treatment of AAA needs to be further explored.

Overview of screening eligibility in patients undergoing ruptured AAA repair from 2003 to 2019 in the Vascular Quality Initiative

ObjectiveAlthough efforts such as the Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act have improved access to abdominal aortic aneurysm (AAA) screening, certain high-risk populations are currently excluded from the guidelines yet may benefit from screening. We therefore examined all patients who underwent repair of ruptured AAA (rAAA) to characterize those who are ineligible for screening under current guidelines and evaluate the potential impact of these restrictions on their disease. MethodsWe identified patients undergoing rAAA repair in the Vascular Quality Initiative (VQI) database between 2003 and 2019. These patients were stratified by AAA screening eligibility according to the Centers for Medicare and Medicaid reimbursement guidelines. We then described baseline characteristics to identify high-risk features of these cohorts. Groups with disproportionate representation in the screening-ineligible cohort were identified as potential targets of screening expansion. Trends over time in screening eligibility and the proportion of AAA repairs performed for rAAA were also analyzed. ResultsA total of 5340 patients underwent rAAA repair. The majority (66%) were screening-ineligible. When characterizing the screening-ineligible group by sex and risk factors (smoking history or family history of AAA), the largest contributors to screening ineligibility were males less than 65 years of age with a smoking history or family history of AAA (25%), males greater than 75 years of age with a smoking history (25%), and females older than 65 years of age with a smoking history (19%). In comparison with rAAAs prior to implementation of the SAAAVE act, the proportion of AAA repair performed for rupture among males undergoing AAA repair in the VQI decreased from 12% to 8% (P < .001), whereas in females, there was no change (P = .990). There was no statically significant difference in screening eligibility for either males (P = .762) or females (P = .335). ConclusionsMost patients who underwent rAAA repair were ineligible for initial AAA screening or aged out of the screening window. Furthermore, rAAA rates and screening ineligibility have not improved as much as expected since the passage of the SAAAVE Act. Our data suggest that three high-risk populations may benefit from expansion of AAA screening guidelines: males with a smoking history or family history of AAA between ages 55 and 64 years, female smokers older than 65 years, and male smokers older than 75 years who are otherwise in good health. Increased efforts to screen these high-risk populations may increase elective AAA repair and minimize the morbidity and mortality associated with rAAAs.

Epidemiology of endovascular and open repair for abdominal aortic aneurysms in the United States from 2004 to 2015 and implications for screening

BackgroundContemporary national trends in the repair of ruptured abdominal aortic aneurysms (AAAs) and intact AAAs are relatively unknown. Furthermore, screening is only covered by insurance for patients aged 65 to 75 years with a family history of AAAs and for men with a positive smoking history. It is unclear what proportion of patients who present with a ruptured AAA would have been candidates for screening. MethodsUsing the National Inpatient Sample from 2004 to 2015, we identified ruptured and intact AAA admissions and repairs using the International Classification of Diseases codes. We generated the screening-eligible cohort using previously identified proportions of male smokers (87%) and all patients with a family history of AAAs (10%) and applied these proportions to patients aged 65 to 75 years. We accounted for those who could have had a previous AAA diagnosis (17%), either from screening or an incidental detection in patients aged >75 years who had presented with AAA rupture. The primary outcomes were treatment and in-hospital mortality between patients meeting the criteria for screening vs those who did not. ResultsWe evaluated 65,125 admissions for ruptured AAAs and 461,191 repairs for intact AAAs. Overall, an estimated 45,037 admitted patients (68%) and 25,777 patients who had undergone repair for ruptured AAAs (59%) did not meet the criteria for screening. Of the patients who did not qualify, 27,653 (63%) were aged >75 years, 10,603 (24%) were aged <65 years, and 16,103 (36%) were women. Endovascular AAA repair (EVAR) increased for ruptured AAAs from 10% in 2004 to 55% in 2015 (P < .001), with operative mortality of 35%. EVAR increased for intact AAAs from 45% in 2004 to 83% in 2015 (P < .001), with operative mortality of 2.0%. ConclusionsMost patients who had undergone repair for ruptured AAAs did not qualify for screening. EVAR was the primary treatment of both ruptured and intact AAAs with relatively low in-hospital mortality. Therefore, expansion of the screening criteria to include selected women and a wider age range should be considered.

Abdominal Aortic Aneurysms No Not Develop More Aggressively Among Patients With a Positive Family History of the Disease

Introduction: It is well known that a family history of Abdominal Aortic Aneurysm (AAA) strongly increases the risk of developing AAA, but it is still unknown whether familial AAAs develop differently than non-familial AAAs. Objectives: To investigate whether familial AAAs develop more aggressively than non-familial AAAs by looking at the growth rate, risk of surgery and rupture, as well as the size of the aneurysm at the time of diagnosis and the patient’s age at the time of operation, rupture and diagnosis. Design: Observational retrospective longitudinal study. Materials and Methods: 318 patients with AAA diagnosed between 1996-2008 in Jutland, Denmark with information on family history of AAA, the diameter of AAA throughout follow-up, surgery, ruptures, comorbidity, smoking, and use of medication. Patients with and without a family history of AAA were compared regarding mean age at diagnosis and surgery, the diameter of AAA at diagnosis, risk of surgery and rupture as well as comorbidity and use of medication. Mean growth rates were compared between the two groups and a mixed-effects model was fitted to control for confounders. Results: We included 93 patients with and 225 without a family history of AAA. Patients with a family history of AAA ere significantly younger than patients with no family history of the disease (69.8 vs. 72.4 years, p=0.032), but we found no significant differences in age at operation (72.2 vs. 70.6, p=0.204), the proportion of patients experiencing rupture (16.0 vs. 10.6%, p=0.226) or undergoing surgery (78.2% vs. 81.7%, p=0.484). We found no significant difference in growth rates between the two groups; 5.25 mm/year for patients with positive family history and 6.19 mm/year for patients with no family history of AAA (p=0.490). Conclusions: We found no evidence to suggest that AAA develops more aggressively in patients with a positive family history of the disease.

Evaluating the prevalence of abdominal aortic aneurysms in the United States through a national screening database

ObjectiveThe U.S. Preventative Services Task Force guidelines for abdominal aortic aneurysm (AAA) screening are based mainly on studies of older Caucasian males from non-U.S. populations. This study was designed to analyze the findings of a large, all-inclusive AAA screening program in the United States. MethodsScreening events were held nationally by a U.S. nonprofit organization between 2001 and 2017. AAA screening was offered regardless of risk profile. Participants filled out a demographics form with known comorbidities. Significant risk factors were determined using logistic regression with backward stepwise variable selection. Odds ratios (OR) are reported with 95% confidence intervals (CIs). ResultsA total of 9457 screened participants (47% male) were analyzed. The mean age was 67 ± 9 years with 40.8% between 65 and 75 years old. Most participants were Caucasian (83.4%), followed by African American (13.1%). Screened risk factors included hypertension (58.1%), hyperlipidemia (54.9%), smoking (52.0%), cardiac disease (29.2%), diabetes mellitus (18.4%), a family history of AAA (22.4%) or brain aneurysms (8.6%), and body mass index (26.9 ± 5.28). Overall, 267 participants (2.82%) were found to have an AAA (>3 cm). Those ages 65 to 75 had a prevalence of 2.98%. In a fully adjusted, multivariate logistic regression, there was an increased risk of AAA in males (OR, 3.24; 95% CI, 2.39-4.40), current smokers (OR, 3.28; 95% CI, 2.36-4.54), previous smokers (OR, 1.86; 95% CI, 1.41-2.47), cardiac disease (OR, 1.30; 95% CI, 1.01-1.68), family history of AAA (OR, 1.60; 95% CI, 1.20-2.14), and advancing age (P < .0001). Female ever smokers 65 to 75 years old had a prevalence of 1.7%. Male smokers 45 to 54 and 55 to 64 years old had a prevalence of 3.37% and 4.43%, respectively. There was an increased risk of AAA in females with morbid obesity (OR, 5.54; 95% CI, 1.34-22.83 in never smokers and OR, 5.61; 95% CI, 1.04-30.15 in smokers), female smokers with hypertension (OR, 3.22; 95% CI, 1.21-8.58), males with cardiac disease (OR, 2.06; 95% CI, 1.08-3.90 in never smokers and OR, 1.48; 95% CI, 1.05-2.09), male smokers with a family history of AAA (OR, 1.69; 95% CI, 1.61-2.46), and current smokers (OR, 6.33; 95% CI, 2.62-15.24 for females and OR, 2.50; 95% CI, 1.70-3.65 for males). ConclusionsThis study shows that there remain high-risk groups outside the current guidelines that would likely benefit from AAA screening. Risk factors for AAA include male gender, smoking, cardiac disease, family history of AAA, and advancing age. The most significant risk factor is current smoking status.

Prevalence of abdominal aortic aneurysms and iliac aneurysms in the UK population of 50,000 women

BACKGROUND AND AIMS: Screening men aged 65–80 years for abdominal aortic aneurysm (AAA) is considered economically viable when the prevalence of AAA is 1.0% or higher. Currently, women are not included in AAA screening programs because the prevalence of AAA is 1.0%. MATERIALS AND METHODS: Risk factors were collected from 50,000 females who attended for cardiovascular screening. Ultrasound was used to detect the presence of AAA or IIA, the severity of carotid atherosclerosis, and the measurement of ankle/brachial index (ABI). Electrocardiogram (ECG) was used to detect the presence of atrial fibrillation (AF). RESULTS: Aneurysms were detected in 116 women. Of these aneurysms, 34 (29%) were IIA and 82 were AAA. The presence of AAA or IA below the age of 66 years was rare (10 of 24,499). In the age group of 66–85, there were 102 (0.41%) in 27,170 women, of which 72 were AAA and 30 IIA. By including IIA in the screening protocol for AAA, it became easy to identify subgroups with an aneurysm prevalence >1%. Univariate analysis demonstrated that the presence of any one of the following risk factors, history of myocardial infarction or coronary artery disease, history of stroke/transient ischemic attack (TIA), pack-years ≥10, AF, ABI 1.0% (range 1.18–2.06). In a multivariable linear logistic regression, age ≥76, hypertension, pack-years, family history of AAA, and history of stroke/TIA were independent predictors for the presence of AAA or IIA. This model had an area under the receiver operator characteristic curve (AUC) of 0.725 (95% confidence interval [CI] 0.673–0.777) and could identify 2947 women who had 41 AAA or IIA present (prevalence 1.39%). By adding ABI and AF, which require a clinical examination and ECG, the receiver operator characteristic (ROC), AUC increased to 0.745 (95% CI 0.693–0.797). This model could identify 3693 women who had 51 AAA or IIA present (prevalence 1.40%). The presence of ≥50% diameter internal carotid stenosis found in 498 women was associated with a prevalence of AAA or IIA of 3.61%, and when added to the model the ROC AUC increased to 0.775 (95% CI 0.724–0.826). This model could identify 3701 women who had 58 AAA or IIA present (prevalence 1.6%). CONCLUSION: The findings of this study have important implications for developing a screening selection plan for women over 65. By including IIA in the screening protocol for AAA, it became easy to identify subgroups with an aneurysm prevalence >1%. The presence of any one or more of the risk factors listed above can be used to develop targeted screening because of increased risk (>1%). However, whether such screening will be associated with benefits can only be determined by randomized controlled trials and cost-benefit studies.

The case for expanding abdominal aortic aneurysm screening

Both the U.S. Preventive Services Task Force and the UK National Institute for Health and Care Excellence are re-evaluating their screening paradigms for abdominal aortic aneurysms (AAAs). Currently, most countries that screen for AAA do so only in male ever-smokers between the ages of 65 and 75 years and in patients with a family history of AAA. However, these recommendations are based primarily on screening trials predating the endovascular era. The wider applicability of endovascular aneurysm repair and its safety profile, especially in the elderly, have changed the risk-benefit of repair and, by extension, screening. This is despite the decreasing prevalence of AAA thanks to improved medical therapies and lower smoking rates. This evidence summary critically examines the evidence behind screening and the potential for expanded screening.

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

Risk Factors for Abdominal Aortic Aneurysm in Population-Based Studies: A Systematic Review and Meta-Analysis.

Abdominal aortic aneurysm (AAA) represents an important public health problem with a prevalence between 1.3% and 12.5%. Several population-based randomized trials have evaluated ultrasound screening for AAA providing evidence of a reduction in aneurysm-related mortality in the screened population. The aim of our study was to perform a systematic review and meta-analysis of the risk factors for AAA. We conducted a systematic review of observational studies and we performed a meta-analysis that evaluated the following risk factors: gender, smoking habits, hypertension, coronary artery disease and family history of AAA. Respect to a previous a meta-analysis we added the funnel plot to examine the effect sizes estimated from individual studies as measure of their precision; sensitivity analysis to check the stability of study findings and estimate how the overall effect size would be modified by removal of one study; cumulative analysis to evaluate the trend between studies in relation to publication year. Abdominal aortic aneurysm prevalence is higher in smokers and in males. On the other hand, while diabetes is a risk factor for many cardiovascular diseases, it is not a risk factor for AAA. In addition, it is important to underline that all countries, where AAA screening was set up, had high income level and the majority belong to Western Europe (United Kingdom, Sweden, Italy, Poland, Spain and Belgium). Abdominal aortic aneurysm screening is fundamental for public health. It could avoid deaths, ruptures, and emergency surgical interventions if abdominal aortic aneurysm was diagnosed early in the population target for screening.

Prevalence and risk factors of sub-renal abdominal aortic aneurysm in an Algerian population aged over 60

The prevalence of abdominal aortic aneurysm (AAA) in the general population in our country is not known, our aim was to evaluate it in patients over 60 years of age, to specify the risk factors and to evaluate the extension of aneurysmal disease and multisite subclinical atherosclerosis. Descriptive, transversal, study collecting the data of a systematic ultrasound screening of sub-renal AAA in subjects receiving care in two Algerian hospital structures. Epidemiological data, AAA risk factors, cardiovascular disease risk factors (CVD RF) and the personal history (cardiovascular diseases, chronic obstructive pulmonary disease) and family history of AAA were collected during the screening. An abdominal echography was performed in all patients. A biological and morphological assessment was carried out for AAA cases detected. Multivariate logistic regression analysis was used to study the factors associated with AAA. Systematic screening for 600 patients revealed an overall AAA prevalence of 2.2% (n=13). In multivariate analysis a positive association with AAA was observed with active smoking, its duration in years and its intensity in year-packages; with hypertension, dyslipidemia and a history of cardiovascular events. While a negative association was observed with a smoking cessation of more than 20 years, type 2 diabetes and android obesity. The study of detected AAA cases found five cases of aneurysm isolated from the primary iliac artery but no popliteal and/or femoral aneurysm. The carotids were atheromatous in more than 80% of cases and the arteries of the lower limbs in more than one-third of cases. The prevalence of AAA in our population (2.2%) corresponds to the prevalence reported recently in Europe, but it would have been higher if the screening had targeted males and smokers. The factors associated with AAA in our patients are similar to those described in the literature.

The prevalence of abdominal aortic aneurysms in the rural/urban population in central Poland - Gniewkowo Aortic Study.

Abdominal aortic aneurysm (AAA) is a widening of the aorta below the renal arteries with a diameter equal to or greater than 3 cm. The prevalence of AAA is estimated at 4-8% in men aged 65 years or older and 1-2% among women over 65 years old. Participation in screening programmes has decreased the number of aortic ruptures. All men aged 60 years and older, and women aged 65 years and older living in the rural/urban commune in central Poland were invited to participate in the study. In total 922 persons (61% of the invited population) entered the study. The men were divided into two groups: 60-64 years old, and 65 years and older. Screening abdomen ultrasound was performed and demographic data was collected. Among the 922 examined persons two (1.01%) AAAs were diagnosed in the group of men 60-64 years of age, three (0.82%) AAAs amongst women ≥ 65 years old, and 33 (9.29%) AAAs were found in the group of men aged 65 years and older. A positive relationship between the presence of AAA and smoking (p = 0.0048), age of men (p = 0.0009), and history of myocardial infarction/acute coronary syndrome (MI/ACS) (p = 0.0079) was found. There was no correlation between the frequency of AAA and diabetes mellitus (p = 0.46), hypertension (p = 0.38), and family history of AAA (p = 0.44). The prevalence of AAA in men aged 65 years and older is seemingly larger than in previously conducted studies, while among men 60-64 years of age and women aged ≥ 65 it is similar. Older age, smoking, and a history of MI/ACS were the most important risk factors of AAA occurrence.

Prevalence of abdominal aortic aneurysms and its relation with cardiovascular risk stratification: protocol of the Risk of Cardiovascular diseases and abdominal aortic Aneurysm in Varese (RoCAV) population based study.

BackgroundRecent meta-analyses suggested that screening program for abdominal aortic aneurysms (AAA) in 65-year old males is cost-effective at prevalence of about 1%. Since some events occur also in females and among the youngers, screening could be feasible among those at higher risk, such as smokers or individuals with a family history of AAA. The RoCAV (Risk of Cardiovascular diseases and abdominal aortic Aneurysms in Varese) Project is a population-based study aimed to evaluate AAA prevalence in Northern Italy in males over-65 years as well as among females and younger males, and to identify new markers for risk stratification by collecting a large set of CVD risk factors. The aims of the project are: (i) cross-sectional evaluation of AAA prevalence (ii); evaluation of standard CVD risk score as criteria for selecting subgroup at higher risk to be included in a screening program; (iii) identification of new risk markers and risk score algorithm for AAA and CVD risk stratification; (iv) cost-effective evaluation during the follow-up.MethodsMales aged 50–75 years and females aged 60–75 years, resident in the city of Varese (Lombardy Region), were randomly selected from the civil registry. Among 5198 successfully invited, 3777 subjects accepted to participate and were finally recruited (participation rate 63.8%) from June 2013 to May 2016. Trained operators administered a computerized anamnestic questionnaire, measured anthropometric parameters (BMI, body circumferences, skinfolds), blood pressure, ankle-brachial index, pulse wave velocity and performed abdominal aortic ultrasound scan, ECG and spirometry. All methods were internationally validated. A blood sample was collected and stored in biobank. A follow-up will be carried out through linkage with electronic records.DiscussionParticipation rate and data quality assessment were as expected and will reasonably allow to reach the project aims. The expected impact in public health of the RoCAV project will be the potential implementation of a AAA screening program to the whole region as well as the formulation of new criteria for risk assessment of AAA and CVD.