Aortic aneurysm screening in general practice

Chronic obstructive pulmonary disease effect on the prevalence and postoperative outcome of abdominal aortic aneurysms: A meta-analysis

Epidemiologic evidence suggested chronic obstructive pulmonary disease (COPD) might increase risk for abdominal aortic aneurysm (AAA). However, the association between COPD and AAA remains inconclusive. We searched PubMed and Cochrane databases until June 2015. Forty-eight articles were included for meta-analysis. COPD was found to be positively associated with AAA, regardless of study design and smoking status. AAA mortality is higher among COPD patients compared with non-COPD patients (postoperative [adjusted OR 2.11; 95% CI 1.33–3.34]; long-term [adjusted OR 1.70; 95% CI 1.37–2.12]). But the association between postoperative mortality and COPD was not found to be significant in patients underwent endovascular aneurysm repair (mixed OR 2.53; 95% CI 0.70–9.18). Rupture AAA may increase the postoperative mortality in COPD patients (rupture [adjusted OR 4.75; 95% CI 2.07–10.89]; non-rupture [adjusted OR 1.97; 95% CI 1.11–3.49]). The AAA postoperative morbidity was found to be positively associated with COPD (adjusted OR 1.59; 95% CI 1.14–2.21). Increased COPD severity may increase the long-term mortality (medical versus oxygen dependent: [OR 1.26; 95% CI 1.07–1.49] versus [OR 2.79; 95% CI 2.24–3.49]). In conclusion, COPD may increase the risk of AAA, morbidity and mortality of AAA patients underwent endovascular aortic repair.

Natural history of abdominal aortic aneurysm with and without coexisting chronic obstructive pulmonary disease

PURPOSE

To study the relation between abdominal aortic aneurysms and chronical obstructive pulmonary disease (COPD), in particular the suggested common elastin degradation caused by elastase and smoking.

METHODS

A cross-sectional population study and a prospective cohort study of small abdominal aortic aneurysms was performed in a community setting. All previous diagnoses recorded in a hospital computer database were received for 4404 men 65 to 73 years of age who had been invited to a population screening for abdominal aortic aneurysm. One hundred forty-one men had AAA (4.2%). They were asked to participate in an interview, a clinical examination, and collection of blood sample. Men with an abdominal aortic aneurysm 3 to 5 cm in diameter were offered annual ultrasound scans to check for expansion.

RESULTS

Among patients with COPD 7.7% had abdominal aortic aneurysms (crude odds ratio=2.05). The adjusted odds ratio, however, was only 1.59 after adjustment for coexisting diseases associated with abdominal aortic aneurysm (P=.13). The mean annual expansion was 2.74 mm per year among patients with COPD, 2.72 among patients without COPD, and 4.7 mm among patients who used oral steroids compared with 2.6 among patients who did not use steroids (P < .05). Concentration of serum elastin peptide and plasma elastase-alpha1-antitrypsin complexes correlated negatively with forced expiratory volume in the first second (FEV1) among patients with COPD. However, multivariate regression analysis showed that concentration of serum elastin peptide, therapy with beta-agonists, and FEV1 correlated positively with degree of expansion but that concentration of plasma elastase-alpha1-antitrypsin complexes and serum alpha1-antitrypsin did not influence expansion, suggesting that elastase plays an important role in the pathogenesis of COPD but not of abdominal aortic aneurysm.

CONCLUSION

The high prevalence of abdominal aortic aneurysm among patients with COPD is more likely to be caused by medication and coexisting diseases rather than a common pathway of pathogenesis.