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Wang Z, You Y, Yin Z, Bao Q, Lei S, Yu J, Xie C, Ye F, Xie X. Burden of Aortic Aneurysm and Its Attributable Risk Factors from 1990 to 2019: An Analysis of the Global Burden of Disease Study 2019. Front Cardiovasc Med 2022; 9:901225. [PMID: 35711350 PMCID: PMC9197430 DOI: 10.3389/fcvm.2022.901225] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/26/2022] [Indexed: 12/18/2022] Open
Abstract
Background Global and national estimates on the epidemiology of aortic aneurysms are prerequisites for disease management and policymaking. Based on the Global Burden of Disease (GBD) 2019, this study aimed to discern the global aortic aneurysm burden by systematically analyzing demographic data on mortality and exploring the attributable risks and relevant factors. Methods The data analyzed in this study were available in the Global Health Data Exchange (GHDx) online query tool. The population in our study comprised individuals from 204 countries and territories from 1990 to 2019. The estimated annual percentage changes (EAPCs) were performed to assess the temporal trends of aortic aneurysms and their attributable risks. Spearman correlation analysis was performed to explore the relationship between the burden of aortic aneurysm and covariates. Results Although aortic aneurysm-related deaths (82.1%) and disability-adjusted life years (DALYs) (67%) increased from 1990 to 2019, the global trend of age-standardized rate of death (ASRD) (EAPC: −1.34, 95% CI = −1.46 to −1.22, P < 0.001) and age-standardized rate of DALY (ASDALYR) (EAPC: −1.06, 95% CI = −1.17 to −0.95, P < 0.001) decreased, both of which presented age dependence and gender differences. Smoking and high systolic blood pressure (SBP) were the main attributable risks of disease burden and tend to decease globally (EAPC: −1.89, 95% CI = −2.03 to −1.89, P < 0.001; −1.31 95% CI = −1.43 to −1.19, P < 0.001, respectively). Alcohol abstinence (male: R = −0.71, P < 0.001; female: R = −0.73, P < 0.001), smoking age of initiation (male: R = −0.32, P < 0.001; female: R = −0.50, P < 0.001), physical activity (male: R = −0.50, P < 0.001; female: R = −0.55, P < 0.001), and mean temperature (R = −0.62, P < 0.001) had negative correlation with ASRD. However, cholesterol level (male: R = 0.62, P < 0.001; female: R = 0.39, P < 0.001), body mass index (BMI) (male: R = 0.30, P < 0.001; female R = −0.01, P > 0.05), and alcohol consumption (male: R = 0.46, P < 0.001; female: R = 0.42, P < 0.001) had a positive correlation with ASRM. Besides, standard of living and medical resources positively related to burden of aortic aneurysm. Conclusion In this study, a decreasing trend of aortic aneurysm burden was found globally, especially in advanced regions. Aged men who smoke and women who have hypertension should pay close attention to, particularly in deprived economic groups, and many approaches can be performed to reduce the burden of aortic aneurysms.
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Affiliation(s)
- Zhuo Wang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- International Institutes of Medicine, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Yayu You
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhehui Yin
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qinyi Bao
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shuxin Lei
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiaye Yu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cuiping Xie
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Feiming Ye
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojie Xie
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Xiaojie Xie
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Ouarab C, Brouri M, Laroche JP, Ayoub S. [Prevalence and risk factors of sub-renal abdominal aortic aneurysm in an Algerian population aged over 60]. JOURNAL DE MÉDECINE VASCULAIRE 2018; 43:361-368. [PMID: 30522708 DOI: 10.1016/j.jdmv.2018.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 09/30/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- C Ouarab
- Service de médecine interne, CHU Beni-Messous, Alger, Algérie.
| | - M Brouri
- Service de médecine interne, clinique Arezki-Kehhal, EPH EL Biar, Alger, Algérie
| | - J P Laroche
- Service de médecine vasculaire, hôpital Saint-Éloi, CHU de Montpellier, 34295 Montpellier cedex 5, France
| | - S Ayoub
- Service de médecine interne, CHU Beni-Messous, Alger, Algérie
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Altobelli E, Rapacchietta L, Profeta VF, Fagnano R. Risk Factors for Abdominal Aortic Aneurysm in Population-Based Studies: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122805. [PMID: 30544688 PMCID: PMC6313801 DOI: 10.3390/ijerph15122805] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/30/2018] [Accepted: 12/05/2018] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Emma Altobelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
- Epidemiology and Biostatistics Unit, Local Health Unit, 64100 Teramo, Italy.
| | | | - Valerio F Profeta
- Department of community Health, Local Health Unit, 64100 Teramo, Italy.
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Niclot J, Stansal A, Saint-Lary O, Lazareth I, Priollet P. [Identifying barriers to screening for abdominal aortic aneurysm in general practice: Qualitative study of 14 general practitioners in Paris]. JOURNAL DE MÉDECINE VASCULAIRE 2018; 43:174-181. [PMID: 29754727 DOI: 10.1016/j.jdmv.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 02/24/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Abdominal aortic aneurysm (AAA) is a silent pathology with often fatal consequences in case of rupture. AAA screening, recommended in France and many other countries, has shown its effectiveness in reducing specific mortality. However, AAA screening rate remains insufficient. OBJECTIVE To identify barriers to AAA screening in general practice. MATERIAL AND METHOD Qualitative study carried out during 2016 among general practitioners based in Paris. RESULTS Fourteen physicians were included. Most of the barriers were related to the physician: unawareness about AAA and screening recommendations, considering AAA as a secondary question not discussed with the patient, abdominal aorta not included in cardiovascular assessment, no search for a familial history of AAA, AAA considered a question for the specialist, lack of time, lack of training, numerous screenings to propose, oversight. Some barriers are related to the patient: unawareness of the pathology and family history of AAA, refusal, questioning the pertinence of the doctor's comments, failure to respect the care pathway. Others are related to AAA: source of anxiety, low prevalence, rarity of complications. The remaining barriers are related to screening: cost-benefit and risk-benefit ratios, sonographer unavailability, constraint for the patient, overmedicalization. CONCLUSION Information and training of general practitioners about AAA must be strengthened in order to optimize AAA screening and reduce specific mortality.
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Affiliation(s)
- J Niclot
- Département de médecine générale, université de Versailles Saint-Quentin-en-Yvelines, UFR des sciences de la santé Simone-Veil, 2, avenue de la Source-de-la-Bièvre, 78180 Montigny-le-Bretonneux; Service de médecine vasculaire, Groupe Hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France.
| | - A Stansal
- Service de médecine vasculaire, Groupe Hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - O Saint-Lary
- Département de médecine générale, université de Versailles Saint-Quentin-en-Yvelines, UFR des sciences de la santé Simone-Veil, 2, avenue de la Source-de-la-Bièvre, 78180 Montigny-le-Bretonneux
| | - I Lazareth
- Service de médecine vasculaire, Groupe Hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - P Priollet
- Service de médecine vasculaire, Groupe Hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
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Hernigou J, Dakhil B, Belmont L, Couffinhal JC, Bagan P. [Sleep apnea syndrome and abdominal aortic aneurysm: Study of the prevalence of sleep apnea syndrome in patients with aneurysm and research of association. Clinical study on 52 patients]. JOURNAL DE MEDECINE VASCULAIRE 2017; 42:162-169. [PMID: 28705405 DOI: 10.1016/j.jdmv.2017.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 02/27/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Prevalence of abdominal aortic aneurysms (AAA) in Europe is between 4.1 % and 8.9 %. The risk of rupture of AAA is related to the evolution of its diameter. The role of sleep apnea (SA) remains still discussed. The objective of this study was to study the prevalence of SA in patients presenting with AAA in comparison with the general population as well as the relation between the AAA diameter and the severity of SA. MATERIALS AND METHODS Between June 2012 and December 2014, we included all patients referred for surgical treatment of an AAA. All the patients had a preoperative polysomnography and angio-scanner. An apnea/hypopnea index (AHI)>10/h was chosen for the diagnosis of SA. SA prevalence was compared with the prevalence in general population. The patients were also divided into two groups according to the severity of SA: group 1 (no SA and light SAS); group 2 (moderate and severe SA). RESULTS Fifty-two patients were included. Fifty-six percent of the patients presented SA - prevalence was significantly higher than in the general population (56 vs. 8 %, P<0.001). The distribution of the two groups was: group 1, n=27 patients, group 2, n=25 patients. AAA diameter and BMI were higher in group 2 than in group 1, respectively 61mm vs. 55mm, P=0.03 and 28 vs. 23, P=0.02. CONCLUSION Prevalence of SA in patients with an AAA seems to be significantly higher than in general population. The growth of the aneurysm seems to be linked to the severity of SA.
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Affiliation(s)
- J Hernigou
- Service de chirurgie vasculaire et thoracique, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prudhon, 95107 Argenteuil, France.
| | - B Dakhil
- Service de chirurgie vasculaire et thoracique, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prudhon, 95107 Argenteuil, France
| | - L Belmont
- Service de pneumologie, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prudhon, 95107 Argenteuil, France
| | - J C Couffinhal
- Service de chirurgie vasculaire et thoracique, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prudhon, 95107 Argenteuil, France
| | - P Bagan
- Service de chirurgie vasculaire et thoracique, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prudhon, 95107 Argenteuil, France
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Ulug P, Powell JT, Sweeting MJ, Bown MJ, Thompson SG. Meta-analysis of the current prevalence of screen-detected abdominal aortic aneurysm in women. Br J Surg 2016; 103:1097-104. [PMID: 27346306 PMCID: PMC6681422 DOI: 10.1002/bjs.10225] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/08/2016] [Accepted: 05/09/2016] [Indexed: 02/02/2023]
Abstract
Background Although women represent an increasing proportion of those presenting with abdominal aortic aneurysm (AAA) rupture, the current prevalence of AAA in women is unknown. The contemporary population prevalence of screen‐detected AAA in women was investigated by both age and smoking status. Methods A systematic review was undertaken of studies screening for AAA, including over 1000 women, aged at least 60 years, done since the year 2000. Studies were identified by searching MEDLINE, Embase and CENTRAL databases until 13 January 2016. Study quality was assessed using the Newcastle–Ottawa scoring system. Results Eight studies were identified, including only three based on population registers. The largest studies were based on self‐purchase of screening. Altogether 1 537 633 women were screened. Overall AAA prevalence rates were very heterogeneous, ranging from 0·37 to 1·53 per cent: pooled prevalence 0·74 (95 per cent c.i. 0·53 to 1·03) per cent. The pooled prevalence increased with both age (more than 1 per cent for women aged over 70 years) and smoking (more than 1 per cent for ever smokers and over 2 per cent in current smokers). Conclusion The current population prevalence of screen‐detected AAA in older women is subject to wide demographic variation. However, in ever smokers and those over 70 years of age, the prevalence is over 1 per cent. Significant in older women who smoke
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Affiliation(s)
- P Ulug
- Vascular Surgery Research Group, Imperial College London, London, UK
| | - J T Powell
- Vascular Surgery Research Group, Imperial College London, London, UK
| | - M J Sweeting
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - M J Bown
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, UK
| | - S G Thompson
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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