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Fasolo F, Winski G, Li Z, Wu Z, Winter H, Ritzer J, Glukha N, Roy J, Hultgren R, Pauli J, Busch A, Sachs N, Knappich C, Eckstein HH, Boon RA, Paloschi V, Maegdefessel L. The circular RNA Ataxia Telangiectasia Mutated regulates oxidative stress in smooth muscle cells in expanding abdominal aortic aneurysms. MOLECULAR THERAPY. NUCLEIC ACIDS 2023; 33:848-865. [PMID: 37680984 PMCID: PMC10481153 DOI: 10.1016/j.omtn.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 08/14/2023] [Indexed: 09/09/2023]
Abstract
An abdominal aortic aneurysm (AAA) is a pathological widening of the aortic wall characterized by loss of smooth muscle cells (SMCs), extracellular matrix degradation, and local inflammation. This condition is often asymptomatic until rupture occurs, leading to high morbidity and mortality rates. Diagnosis is mostly accidental and the only currently available treatment option remains surgical intervention. Circular RNAs (circRNAs) represent a novel class of regulatory non-coding RNAs that originate from backsplicing. Their highly stable loop structure, combined with a remarkable enrichment in body fluids, make circRNAs promising disease biomarkers. We investigated the contribution of circRNAs to AAA pathogenesis and their potential application to improve AAA diagnostics. Gene expression analysis revealed the presence of deregulated circular transcripts stemming from AAA-relevant gene loci. Among these, the circRNA to the Ataxia Telangiectasia Mutated gene (cATM) was upregulated in human AAA specimens, in AAA-derived SMCs, and serum samples collected from aneurysm patients. In primary aortic SMCs, cATM increased upon angiotensin II and doxorubicin stimulation, while its silencing triggered apoptosis. Higher cATM levels made AAA-derived SMCs less vulnerable to oxidative stress, compared with control SMCs. These data suggest that cATM contributes to elicit an adaptive oxidative-stress response in SMCs and provides a reliable AAA disease signature.
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Affiliation(s)
- Francesca Fasolo
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, 81675 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 10785 Berlin, Germany
| | - Greg Winski
- Department of Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Zhaolong Li
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, 81675 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 10785 Berlin, Germany
| | - Zhiyan Wu
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, 81675 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 10785 Berlin, Germany
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology and Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing 100730, P.R. China
| | - Hanna Winter
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, 81675 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 10785 Berlin, Germany
| | - Julia Ritzer
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, 81675 Munich, Germany
| | - Nadiya Glukha
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, 81675 Munich, Germany
| | - Joy Roy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 17176 Stockholm, Sweden
- Department of Vascular Surgery, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 17176 Stockholm, Sweden
- Department of Vascular Surgery, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Jessica Pauli
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, 81675 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 10785 Berlin, Germany
| | - Albert Busch
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, 81675 Munich, Germany
- Division of Vascular and Endovascular Surgery, Department of Visceral, Thoracic and Vascular Surgery, Medical Faculty, Carl Gustav Carus and University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, 01307 Dresden, Germany
| | - Nadja Sachs
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, 81675 Munich, Germany
| | - Christoph Knappich
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, 81675 Munich, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, 81675 Munich, Germany
| | - Reinier A. Boon
- German Center for Cardiovascular Research DZHK 10785 Berlin, Partner Site Frankfurt Rhine-Main, Frankfurt am Main, Germany
- Institute of Cardiovascular Regeneration, Goethe University, 60590 Frankfurt am Main, Germany
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Physiology, 1081 Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Microcirculation, 1081 Amsterdam, the Netherlands
| | - Valentina Paloschi
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, 81675 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 10785 Berlin, Germany
| | - Lars Maegdefessel
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, 81675 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 10785 Berlin, Germany
- Department of Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
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Kristensen JSS, Obel LM, Dahl M, Høgh A, Lindholt JS. Gender-specific Predicted Normal Aortic Size and Its Consequences of the Population-Based Prevalence of Abdominal Aortic Aneurysms. Ann Vasc Surg 2023; 91:127-134. [PMID: 36563844 DOI: 10.1016/j.avsg.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/07/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND To investigate if a relative-size-index of the abdominal aortic diameter influences the prevalence estimates of abdominal aortic dilatations compared to absolute diameters. METHODS Cross-sectional study. Participants from the Viborg Vascular Screening Trial, Viborg Women Cohort, and the Viborg Screening Program. Through multivariate linear regression analyses, 2 gender-specific prediction-equations were developed based upon body-surface area and age. The definitions of absolute and relative size of aortic ectasies were 25-29 mm and 1.25-1.49× individual-predicted size (IPS), abdominal aortic aneurysm (AAA) 30 mm and 1.5× IPS, and large repair-recommendable AAA ≥55 mm or ≥ 2.75× IPS, respectively. RESULTS Nineteen thousand two hundred and sixty nine males (69.6 years) and 2,426 females (67.1 years) attended the population- and ultrasound-based screening studies for AAA. The mean peak systolic abdominal anterior-posterior inner to inner diameter was 19.1 mm (±5.3 mm) and 16.6 mm (±2.8 mm) (P < 0.001) in males and females, respectively. Body surface area showed the strongest correlation with aortic diameters in both males (r = 0.19, P < 0.001) and females (r = 0.17, P < 0.001). Age correlated significantly with size, but only in males (r = 0.03, P < 0.001). The prevalence in men of absolute size-defined and relative size index-defined screening-detected aortic ectasies, AAAs and repair-recommendable AAAs were: 5.9% and 9.5% (P < 0.001), 3.3% and 4.2% (P < 0.001) and 9.9% and 15.2% (P = 0.004), respectively. Prevalence in females of absolute-size-defined and relative-size-index-defined screening-detected aortic ectasies, AAAs and repair-recommendable AAAs were 1.2% and 5.8% (P < 0.001), 0.5% and 1.3% (P = 0.003) and 0.0% and 23.1% (P = 0.553), respectively. CONCLUSIONS Despite statistical differences, ultrasound-based absolute diameters to detect AAA seem acceptable in men. In females, poor agreements were noticed concerning all 3 categories of aneurysms, indicating that the current absolute diagnostic cut-points do not reflect female anatomy.
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Affiliation(s)
- Joachim S S Kristensen
- Department of Cardiothoracic and Vascular Surgery, University Hospital of Odense, Odense C, Denmark; University Hospital of Odense, Elitary research Centre of Individualized Medicine in Arterial Disease (CIMA), Denmark; Cardiovascular Centre of Excellence in Southern Denmark (CAVAC), Denmark.
| | - Lasse M Obel
- Department of Cardiothoracic and Vascular Surgery, University Hospital of Odense, Odense C, Denmark; University Hospital of Odense, Elitary research Centre of Individualized Medicine in Arterial Disease (CIMA), Denmark; Cardiovascular Centre of Excellence in Southern Denmark (CAVAC), Denmark
| | - Marie Dahl
- Department of Surgery, Vascular Research Unit, Viborg Regional Hospital, Viborg, Denmark; Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Cardiac, Thoracic, and Vascular Research Unit, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Annette Høgh
- Department of Surgery, Vascular Research Unit, Viborg Regional Hospital, Viborg, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Jes S Lindholt
- Department of Cardiothoracic and Vascular Surgery, University Hospital of Odense, Odense C, Denmark; University Hospital of Odense, Elitary research Centre of Individualized Medicine in Arterial Disease (CIMA), Denmark; Cardiovascular Centre of Excellence in Southern Denmark (CAVAC), Denmark; Department of Surgery, Vascular Research Unit, Viborg Regional Hospital, Viborg, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
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Li W, Liao T, Zhang Y, Li C. Using red blood cell distribution width to predict death after abdominal aortic aneurysm rupture. BMC Cardiovasc Disord 2023; 23:172. [PMID: 36997845 PMCID: PMC10061891 DOI: 10.1186/s12872-023-03191-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/21/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND An abdominal aortic aneurysm is a life-threatening enlargement in the major vessel at the abdomen level. This study investigated the associations between different levels of red blood cell distribution width and all-cause mortality among patients with abdominal aortic aneurysm rupture. It developed predictive models for all-cause mortality risk. METHODS This was a retrospective cohort study using 2001 to 2012 MIMIC-III dataset. The study sample included 392 U.S. adults with abdominal aortic aneurysms who were admitted to ICU after the aneurysm rupture. Then we used two single-factor and four multivariable logistic regression models to examine the associations between different levels of red blood cell distribution and all-cause mortality (30 days and 90 days), controlling for demographics, comorbidities, vital signs, and other laboratory measurements. The receiver operator characteristic curves were calculated, and the areas under the curves were recorded. RESULTS There were 140 (35.7%) patients with an abdominal aortic aneurysm in the red blood cell distribution width range between 11.7 and 13.8%, 117 (29.8%) patients in the range between 13.9 and 14.9%, and 135 (34.5%) patients in the range between 15.0 and 21.6%. Patients with higher red blood cell distribution width level (> 13.8%) tended to have a higher mortality rate (both 30 days and 90 days), congestive heart failure, renal failure, coagulation disorders, lower hemoglobin, hematocrit, MCV, red blood cell count, higher levels of chloride, creatinine, sodium, and BUN (All P < 0.05). Results of multivariate logistic regression models indicated that patients with higher red blood cell distribution width levels (> 13.8%) had the highest statistically significant odd ratios of 30 days and 90 days of all-cause mortality than lower red blood cell distribution width levels. The area under the RDW curve was lower (P = 0.0009) than that of SAPSII scores. CONCLUSIONS Our study found that patients with abdominal aortic aneurysm rupture with a higher blood cell distribution had the highest risk of all-cause mortality. Using the blood cell distribution width level in patients with abdominal aortic aneurysm rupture to predict mortality should be considered in future clinical practice.
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Affiliation(s)
- Wanghai Li
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Tao Liao
- Department of Critical Care Medicine, Renmin Hospital, Hubei University of Medicine, Shiyan City, 442000, People's Republic of China
| | - Yan Zhang
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Chengzhi Li
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
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Automatic Detection and Segmentation of Thrombi in Abdominal Aortic Aneurysms Using a Mask Region-Based Convolutional Neural Network with Optimized Loss Functions. SENSORS 2022; 22:s22103643. [PMID: 35632050 PMCID: PMC9145191 DOI: 10.3390/s22103643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/27/2022] [Accepted: 05/09/2022] [Indexed: 11/28/2022]
Abstract
The detection and segmentation of thrombi are essential for monitoring the disease progression of abdominal aortic aneurysms (AAAs) and for patient care and management. As they have inherent capabilities to learn complex features, deep convolutional neural networks (CNNs) have been recently introduced to improve thrombus detection and segmentation. However, investigations into the use of CNN methods is in the early stages and most of the existing methods are heavily concerned with the segmentation of thrombi, which only works after they have been detected. In this work, we propose a fully automated method for the whole process of the detection and segmentation of thrombi, which is based on a well-established mask region-based convolutional neural network (Mask R-CNN) framework that we improve with optimized loss functions. The combined use of complete intersection over union (CIoU) and smooth L1 loss was designed for accurate thrombus detection and then thrombus segmentation was improved with a modified focal loss. We evaluated our method against 60 clinically approved patient studies (i.e., computed tomography angiography (CTA) image volume data) by conducting 4-fold cross-validation. The results of comparisons to multiple other state-of-the-art methods suggested the superior performance of our method, which achieved the highest F1 score for thrombus detection (0.9197) and outperformed most metrics for thrombus segmentation.
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Abstract
Abdominal aortic aneurysm (AAA) disease remains a major source of morbidity in developed countries and can progress to life-threatening rupture if left untreated, with exceedingly high mortality. The goal of AAA management is to identify and electively repair AAAs before rupture. AAA disease burden and outcomes have improved over time with declining tobacco use and advancements in care across patients' disease course. The introduction of endovascular AAA repair, in particular, has allowed for elective AAA repair in patients previously considered too high risk for open surgery and has contributed to lower rates of AAA rupture over time. However, these improved outcomes are not universally experienced, and disparities continue to exist in the detection, treatment, and outcomes of AAA by sex, race, and ethnicity. Mitigating these disparities requires enhanced, focused efforts at preventing disease, promoting health, and delivering appropriate care among an increasingly diverse patient population.
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Affiliation(s)
- Christina L Marcaccio
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 110 Francis Street, Suite 5B, Boston, MA 02215
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 110 Francis Street, Suite 5B, Boston, MA 02215.
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Ghoneim B, Elsherif M, Elsharkawi M, Acharya Y, Hynes N, Tawfick W, Sultan S. Outcomes of Unibody Bifurcated Endograft and Aortobifemoral Bypass for Aortoiliac Occlusive Disease. Vasc Specialist Int 2020; 36:216-223. [PMID: 33361542 PMCID: PMC7790696 DOI: 10.5758/vsi.200051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/01/2020] [Accepted: 11/23/2020] [Indexed: 11/20/2022] Open
Abstract
Purpose We compared the outcomes between the total endovascular approach using a unibody bifurcated aortoiliac endograft and the gold standard aortobifemoral bypass (ABF) surgery for the management of extensive aortoiliac occlusive disease (AIOD). Methods Materials and This retrospective observational study compared the outcomes of endovascular technique with unibody bifurcated endograft (UBE) using the Endologix AFX unibody stent-graft and a standard surgical approach (ABF) in the management of AIOD based on patient records in Western Vascular Institute, Galway University Hospital, National University of Ireland. Procedural details and outcomes were documented to compare both groups. Results From January 2002 to December 2018, 67 patients underwent AIOD (20 UBE and 47 ABF). Both the ABF and UBE groups showed 100% immediate clinical and technical successes without 30-day mortality. There were no statistical differences in the overall survival and sustained clinical improvement between the bypass and the UBE groups; however, statistically significant differences were observed in 3-year freedom from re-intervention and amputation-free survival. Furthermore, the mean length of the intensive care unit (ICU) stay was significantly lower in the UBE group than that in the ABF group (0.75 days vs. 3.1 days, P=0.001). Conclusion Total endovascular reconstruction of AIOD is an alternative to invasive bypass procedures, with a shorter ICU stay.
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Affiliation(s)
- Baker Ghoneim
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, Galway, Ireland.,Department of Vascular Surgery, Cairo University Hospitals, Cairo, Egypt
| | - Mohamed Elsherif
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, Galway, Ireland
| | - Mohamed Elsharkawi
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, Galway, Ireland
| | - Yogesh Acharya
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, Galway, Ireland.,Department of Vascular surgery, Galway Clinic, Galway, Ireland
| | - Niamh Hynes
- Department of Vascular surgery, Galway Clinic, Galway, Ireland
| | - Wael Tawfick
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, Galway, Ireland
| | - Sherif Sultan
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, Galway, Ireland.,Department of Vascular surgery, Galway Clinic, Galway, Ireland
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Owens DK, Davidson KW, Krist AH, Barry MJ, Cabana M, Caughey AB, Doubeni CA, Epling JW, Kubik M, Landefeld CS, Mangione CM, Pbert L, Silverstein M, Simon MA, Tseng CW, Wong JB. Screening for Abdominal Aortic Aneurysm: US Preventive Services Task Force Recommendation Statement. JAMA 2019; 322:2211-2218. [PMID: 31821437 DOI: 10.1001/jama.2019.18928] [Citation(s) in RCA: 168] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
IMPORTANCE An abdominal aortic aneurysm (AAA) is typically defined as aortic enlargement with a diameter of 3.0 cm or larger. The prevalence of AAA has declined over the past 2 decades among screened men 65 years or older in various European countries. The current prevalence of AAA in the United States is unclear because of the low uptake of screening. Most AAAs are asymptomatic until they rupture. Although the risk for rupture varies greatly by aneurysm size, the associated risk for death with rupture is as high as 81%. OBJECTIVE To update its 2014 recommendation, the USPSTF commissioned a review of the evidence on the effectiveness of 1-time and repeated screening for AAA, the associated harms of screening, and the benefits and harms of available treatments for small AAAs (3.0-5.4 cm in diameter) identified through screening. POPULATION This recommendation applies to asymptomatic adults 50 years or older. However, the randomized trial evidence focuses almost entirely on men aged 65 to 75 years. EVIDENCE ASSESSMENT Based on a review of the evidence, the USPSTF concludes with moderate certainty that screening for AAA in men aged 65 to 75 years who have ever smoked is of moderate net benefit. The USPSTF concludes with moderate certainty that screening for AAA in men aged 65 to 75 years who have never smoked is of small net benefit. The USPSTF concludes that the evidence is insufficient to determine the net benefit of screening for AAA in women aged 65 to 75 years who have ever smoked or have a family history of AAA. The USPSTF concludes with moderate certainty that the harms of screening for AAA in women aged 65 to 75 years who have never smoked and have no family history of AAA outweigh the benefits. RECOMMENDATIONS The USPSTF recommends 1-time screening for AAA with ultrasonography in men aged 65 to 75 years who have ever smoked. (B recommendation) The USPSTF recommends that clinicians selectively offer screening for AAA with ultrasonography in men aged 65 to 75 years who have never smoked rather than routinely screening all men in this group. (C recommendation) The USPSTF recommends against routine screening for AAA with ultrasonography in women who have never smoked and have no family history of AAA. (D recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for AAA with ultrasonography in women aged 65 to 75 years who have ever smoked or have a family history of AAA. (I statement).
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Affiliation(s)
| | - Douglas K Owens
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Stanford University, Stanford, California
| | - Karina W Davidson
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
| | - Alex H Krist
- Fairfax Family Practice Residency, Fairfax, Virginia
- Virginia Commonwealth University, Richmond
| | | | | | | | | | | | | | | | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
| | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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Guirguis-Blake JM, Beil TL, Senger CA, Coppola EL. Primary Care Screening for Abdominal Aortic Aneurysm: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2019; 322:2219-2238. [PMID: 31821436 DOI: 10.1001/jama.2019.17021] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Ruptured abdominal aortic aneurysms (AAAs) have mortality estimated at 81%. OBJECTIVE To systematically review the evidence on benefits and harms of AAA screening and small aneurysm treatment to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed (publisher supplied only), Database of Abstracts of Reviews of Effects, and Cochrane Central Register of Controlled Trials for relevant English-language studies published through September 2018. Surveillance continued through July 2019. STUDY SELECTION Trials of AAA screening benefits and harms; trials and cohort studies of small (3.0-5.4 cm) AAA treatment benefits and harms. DATA EXTRACTION AND SYNTHESIS Two investigators independently reviewed abstracts and full-text articles and extracted data. The Peto method was used to pool odds ratios (ORs) for AAA-related mortality, rupture, and operations; the DerSimonian and Laird random-effects model was used to pool calculated risk ratios for all-cause mortality. MAIN OUTCOMES AND MEASURES AAA and all-cause mortality; AAA rupture; treatment complications. RESULTS Fifty studies (N = 323 279) met inclusion criteria. Meta-analysis of population-based randomized clinical trials (RCTs) estimated that a screening invitation to men 65 years or older was associated with a reduction in AAA-related mortality over 12 to 15 years (OR, 0.65 [95% CI, 0.57-0.74]; 4 RCTs [n = 124 926]), AAA-related ruptures over 12 to 15 years (OR, 0.62 [95% CI, 0.55-0.70]; 4 RCTs [n = 124 929]), and emergency surgical procedures over 4 to 15 years (OR, 0.57 [95% CI, 0.48-0.68]; 5 RCTS [n = 175 085]). In contrast, no significant association with all-cause mortality benefit was seen at 12- to 15-year follow-up (relative risk, 0.99 [95% CI 0.98-1.00]; 4 RCTs [n = 124 929]). One-time screening was associated with significantly more procedures over 4 to 15 years in the invited group compared with the control group (OR, 1.44 [95% CI, 1.34-1.55]; 5 RCTs [n = 175 085]). Four trials (n = 3314) of small aneurysm surgical treatment demonstrated no significant difference in AAA-related mortality or all-cause mortality compared with surveillance over 1.7 to 12 years. These 4 early surgery trials showed a substantial increase in procedures in the early surgery group. For small aneurysm treatment, registry data (3 studies [n = 14 424]) showed that women had higher surgical complications and postoperative mortality compared with men. CONCLUSIONS AND RELEVANCE One-time AAA screening in men 65 years or older was associated with decreased AAA-related mortality and rupture rates but was not associated with all-cause mortality benefit. Higher rates of elective surgery but no long-term differences in quality of life resulted from screening.
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Affiliation(s)
- Janelle M Guirguis-Blake
- Department of Family Medicine, University of Washington, Tacoma
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Tracy L Beil
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Caitlyn A Senger
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Erin L Coppola
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Kaiser Permanente Center for Health Research, Portland, Oregon
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Dresios C, Rachiotis G, Symvoulakis EK, Rousou X, Papagiannis D, Mouchtouri V, Hadjichristodoulou C. Nationwide Epidemiological Study of Knowledge, Attitudes, and Practices Study of Greek General Practitioners Related to Screening. Int J Prev Med 2019; 10:199. [PMID: 31772731 PMCID: PMC6868648 DOI: 10.4103/ijpvm.ijpvm_46_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/26/2018] [Indexed: 01/17/2023] Open
Abstract
Background: We aimed to assess general practitioners’ (GPs) knowledge, attitudes, and practices (KAPs) toward screening recommendation guidelines of the United States Preventive Services Task Force (USPSTF). Methods: The survey was conducted during a 6-month period in a stratified random sample of GPs, drawn from a national database of GPs in Greece. Participants were queried about their knowledge, attitudes, and self-reported practice patterns regarding screening in a primary care setting. Sociodemographic characteristics associated with vague screening practicing were identified using multivariable logistic regression models. Results: A total of 299 participants agreed and underwent telephonic survey (response rate: 78.2%). GPs agreed on the key role of population-based screening in improving patient care, and nine out of ten reported that their performance would be improved with the adoption of computer-based support systems in clinical practice. GPs, older than 50 years of age, those who those practicing for more than 15 years and GPs working in private sector, were less likely to comply with screening recommendations. Latent class analysis revealed that male physicians and those working in public sector were more likely to comply with USPSTF recommendations. Conclusions: Our findings highlight the need of educational intervention programs for GPs in order to promote the implementation of national evidence-based screening recommendation statements in clinical practice.
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Affiliation(s)
- Christos Dresios
- Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - George Rachiotis
- Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | | | - Xanthi Rousou
- Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Dimitrios Papagiannis
- Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Varvara Mouchtouri
- Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Larissa, Greece
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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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12
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Sherwood LM, Keadle H, Lesar CJ, Giles WH. Infrarenal Infected Aneurysm of Abdominal Aorta Caused by Clostridium Perfringens. Am Surg 2017. [DOI: 10.1177/000313481708300203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Laura M. Sherwood
- Department of Surgery University of Tennessee College of Medicine Chattanooga Chattanooga, Tennessee
| | - Homer Keadle
- Department of Surgery University of Tennessee College of Medicine Chattanooga Chattanooga, Tennessee
| | - Christopher J. Lesar
- Department of Surgery University of Tennessee College of Medicine Chattanooga Chattanooga, Tennessee
| | - W. Heath Giles
- Department of Surgery University of Tennessee College of Medicine Chattanooga Chattanooga, Tennessee
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13
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Beckerman W, Lajos PS, Faries PL. Endovascular Aortic Aneurysm Repair. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - Paul S. Lajos
- Icahn School of Medicine at Mount Sinai; New York NY USA
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Corrado G, Durante A, Genchi V, Trabattoni L, Beretta S, Rovelli E, Foglia-Manzillo G, Ferrari G. Prevalence of previously undiagnosed abdominal aortic aneurysms in the area of Como: the ComoCuore “looking for AAA” ultrasonography screening. Int J Cardiovasc Imaging 2016; 32:1213-7. [DOI: 10.1007/s10554-016-0911-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/09/2016] [Indexed: 12/15/2022]
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Lahoz C, Gracia CE, García LR, Montoya SB, Hernando ÁB, Heredero ÁF, Tembra MS, Velasco MB, Guijarro C, Ruiz EB, Pintó X, de Ceniga MV, Moñux Ducajú G. [Not Available]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2016; 28 Suppl 1:1-49. [PMID: 27107212 DOI: 10.1016/s0214-9168(16)30026-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Carlos Lahoz
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Carlos III, Madrid, España.
| | - Carlos Esteban Gracia
- Servicio de Angiología y Cirugía Vascular, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | | | - Sergi Bellmunt Montoya
- Servicio de Angiología y Cirugía Vascular, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Ángel Brea Hernando
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital San Pedro, Logroño, España
| | | | - Manuel Suárez Tembra
- Unidad de Lípidos y Riesgo Cardiovascular, Servicio de Medicina Interna, Hospital San Rafael, A Coruña, España
| | - Marta Botas Velasco
- Servicio de Angiología y Cirugía Vascular, Hospital de Cabueñes, Gijón, España
| | - Carlos Guijarro
- Consulta de Riesgo Vascular, Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Esther Bravo Ruiz
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario de Basurto, Bilbao, España
| | - Xavier Pintó
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, L' Hospitalet de Llobregat, Barcelona, España
| | - Melina Vega de Ceniga
- Servicio de Angiología y Cirugía Vascular, Hospital de Galdakao-Usansolo, Vizcaya, España
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Ayça B, Rakıcı T, Atıcı Y, Avsar M, Yuksel Y, Akın F, Okuyan E, Hakan Dinckal M. Adult degenerative scoliosis associated with increased aortic diameter and plaque burden and composition. Vascular 2015. [PMID: 26223527 DOI: 10.1177/1708538115597371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE In this study, we aimed to investigate the relationship between adult degenerative scoliosis (ADS) and the aortic plaques and diameters. METHOD We included 219 patients with ADS and 100 control patients without ADS. Diameters of ascending, arch, descending and abdominal aorta and number, localization and types of the aortic plaques, and the Cobb angles of all patients were measured from computed tomography (CT) images. We divided the patients with ADS into three groups according to the Cobb angle, and divided them into four groups according to level of spine deformity. RESULTS The patients with ADS had a larger aorta and more aortic plaques (both, p < 0.001). The patients with ADS had more fibro-fatty and mix plaques (both, p < 0.001). The patients with severe ADS had larger diameters of the ascending and arch of the aorta (p = 0.026 and p = 0.027, respectively). The patients with the main thoracic curve had a larger ascending aorta and the patients with a thoracolumbar curve had more aortic plaques (p = 0.035 and p = 0.029, respectively). In multivariate regression analysis, the ADS was an independent risk factor for both aortic dilatation (>3.6 cm) and aortic plaque build-up (both, p < 0.001). CONCLUSION The ADS may be a risk factor for aortic dilatation and aortic atherosclerosis.
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Affiliation(s)
- Burak Ayça
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
| | - Taşkın Rakıcı
- Department of Radiology, Samatya Education and Research Hospital, Istanbul, Turkey
| | - Yunus Atıcı
- Department of Orthopaedics and Traumatology, Metin Sabancı Baltalimanı Bone Disease Education and Research Hospital, Istanbul, Turkey
| | - Murat Avsar
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
| | - Yasin Yuksel
- Department of Cardiology, Samatya Education and Research Hospital, Istanbul, Turkey
| | - Fatih Akın
- School of Medicine, Department of Cardiology, Muğla Sıtkı Kocman University, Muğla, Turkey
| | - Ertugrul Okuyan
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
| | - M Hakan Dinckal
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
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Brunner-Ziegler S, Hammer A, Seidinger D, Willfort-Ehringer A, Koppensteiner R, Steiner S. The role of intraluminal thrombus formation for expansion of abdominal aortic aneurysms. Wien Klin Wochenschr 2015; 127:549-54. [DOI: 10.1007/s00508-015-0798-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 04/21/2015] [Indexed: 11/25/2022]
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Jahangir E, Lipworth L, Edwards TL, Kabagambe EK, Mumma MT, Mensah GA, Fazio S, Blot WJ, Sampson UKA. Smoking, sex, risk factors and abdominal aortic aneurysms: a prospective study of 18 782 persons aged above 65 years in the Southern Community Cohort Study. J Epidemiol Community Health 2015; 69:481-8. [PMID: 25563744 DOI: 10.1136/jech-2014-204920] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/17/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) is a leading cause of death in the USA. We evaluated the incidence and predictors of AAA in a prospectively followed cohort. METHODS We calculated age-adjusted AAA incidence rates (IR) among 18 782 participants aged ≥65 years in the Southern Community Cohort Study who received Medicare coverage from 1999-2012, and assessed predictors of AAA using multivariable Cox proportional hazards models, overall and stratified by sex, adjusting for demographic, lifestyle, socioeconomic, medical and other factors. HRs and 95% CIs were calculated for AAA in relation to factors ascertained at enrolment. RESULTS Over a median follow-up of 4.94 years, 281 cases were identified. Annual IR was 153/100,000, 401, 354 and 174 among blacks, whites, men and women, respectively. AAA risk was lower among women (HR 0.48, 95% CI 0.36 to 0.65) and blacks (HR 0.51, 95% CI 0.37 to 0.69). Smoking was the strongest risk factor (former: HR 1.91, 95% CI 1.27 to 2.87; current: HR 5.55, 95% CI 3.67 to 8.40), and pronounced in women (former: HR 3.4, 95% CI 1.83 to 6.31; current: HR 9.17, 95% CI 4.95 to 17). A history of hypertension (HR 1.44, 95% CI 1.04 to 2.01) and myocardial infarction or coronary artery bypass surgery (HR 1.9, 95% CI 1.37 to 2.63) was negatively associated, whereas a body mass index ≥25 kg/m(2) (HR 0.72; 95% CI 0.53 to 0.98) was protective. College education (HR 0.6, 95% CI 0.37 to 0.97) and black race (HR 0.44, 95% CI 0.28 to 0.67) were protective among men. CONCLUSIONS Smoking is a major risk factor for incident AAA, with a strong and similar association between men and women. Further studies are needed to evaluate benefits of ultrasound screening for AAA among women smokers.
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Affiliation(s)
- Eiman Jahangir
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA John Ochsner Heart and Vascular Institute, Ochsner Clinical School- The University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Loren Lipworth
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Todd L Edwards
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Edmond K Kabagambe
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael T Mumma
- International Epidemiology Institute, Rockville, Maryland, USA
| | - George A Mensah
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sergio Fazio
- Center of Preventive Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - William J Blot
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA International Epidemiology Institute, Rockville, Maryland, USA
| | - Uchechukwu K A Sampson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Sohrabi S, Wheatcroft S, Barth JH, Bailey MA, Johnson A, Bridge K, Griffin K, Baxter PD, Scott DJA. Cardiovascular risk in patients with small and medium abdominal aortic aneurysms, and no history of cardiovascular disease. Br J Surg 2014; 101:1238-43. [DOI: 10.1002/bjs.9567] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 08/19/2013] [Accepted: 04/17/2014] [Indexed: 12/31/2022]
Abstract
Abstract
Background
Cardiovascular disease (CVD) is the main cause of death in people with abdominal aortic aneurysm (AAA). There is little evidence that screening for AAA reduces all-cause or cardiovascular mortality. The aim of the study was to assess whether subjects with a small or medium AAA (3·0–5·4 cm), without previous history of clinical CVD, had raised levels of CVD biomarkers or increased total mortality.
Methods
This prospective study included subjects with a small or medium AAA and controls, all without a history of clinical CVD. CVD biomarkers (high-sensitivity C-reactive protein, hs-CRP; heart-type fatty acid-binding protein, H-FABP) were measured, and survival was recorded.
Results
Of a total of 815 people, 476 with an AAA and 339 controls, a cohort of 86 with small or medium AAA (3–5·4 cm) and 158 controls, all with no clinical history of CVD, were identified. The groups were matched for age and sex. The AAA group had higher median (i.q.r.) levels of hs-CRP (2·8 (1·2–6·0) versus 1·3 (0·5–3·5) mg/l; P < 0·001) and H-FABP (4·6 (3·5–6·0) versus 4·0 (3·3–5·1) µg/l; P = 0·011) than controls. Smoking was more common in the AAA group; however, hs-CRP and H-FABP levels were not related to smoking. Mean survival was lower in the AAA group: 6·3 (95 per cent confidence interval (c·i.) 5·6 to 6·9) years versus 8·0 (7·6 to 8·1) years in controls (P < 0·001). Adjusted mortality was higher in the AAA group (hazard ratio 3·41, 95 per cent c·i. 2·11 to 9·19; P < 0·001).
Conclusion
People with small or medium AAA and no clinical symptoms of CVD have higher levels of hs-CRP and H-FABP, and higher mortality compared with controls. They should continue to receive secondary prevention against CVD.
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Affiliation(s)
- S Sohrabi
- Leeds Vascular Institute, Leeds, UK
- Leeds General Infirmary Teaching Hospital NHS Trust, Leeds, UK
- Institute for Genetics Health and Therapeutics, Multidisciplinary Cardiovascular Research Centre (MCRC), Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
| | - S Wheatcroft
- Institute for Genetics Health and Therapeutics, Multidisciplinary Cardiovascular Research Centre (MCRC), Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
| | - J H Barth
- Blood Sciences, Leeds General Infirmary, Leeds, UK
| | - M A Bailey
- Leeds Vascular Institute, Leeds, UK
- Leeds General Infirmary Teaching Hospital NHS Trust, Leeds, UK
- Institute for Genetics Health and Therapeutics, Multidisciplinary Cardiovascular Research Centre (MCRC), Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
| | - A Johnson
- Leeds Vascular Institute, Leeds, UK
- Leeds General Infirmary Teaching Hospital NHS Trust, Leeds, UK
- Institute for Genetics Health and Therapeutics, Multidisciplinary Cardiovascular Research Centre (MCRC), Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
| | - K Bridge
- Leeds Vascular Institute, Leeds, UK
- Leeds General Infirmary Teaching Hospital NHS Trust, Leeds, UK
- Institute for Genetics Health and Therapeutics, Multidisciplinary Cardiovascular Research Centre (MCRC), Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
| | - K Griffin
- Leeds Vascular Institute, Leeds, UK
- Leeds General Infirmary Teaching Hospital NHS Trust, Leeds, UK
- Institute for Genetics Health and Therapeutics, Multidisciplinary Cardiovascular Research Centre (MCRC), Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
| | - P D Baxter
- Leeds Centre for Epidemiology and Biostatistics, MCRC, University of Leeds, Leeds, UK
| | - D J A Scott
- Leeds Vascular Institute, Leeds, UK
- Leeds General Infirmary Teaching Hospital NHS Trust, Leeds, UK
- Institute for Genetics Health and Therapeutics, Multidisciplinary Cardiovascular Research Centre (MCRC), Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
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Sampson UKA, Norman PE, Fowkes FGR, Aboyans V, Song Y, Harrell Jr. FE, Forouzanfar MH, Naghavi M, Denenberg JO, McDermott MM, Criqui MH, Mensah GA, Ezzati M, Murray C. Estimation of Global and Regional Incidence and Prevalence of Abdominal
Aortic Aneurysms 1990 to 2010. Glob Heart 2014; 9:159-70. [DOI: 10.1016/j.gheart.2013.12.009] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Nguyen ATV, Hill GB, Versteeg MPT, Thomson IA, van Rij AM. Novices may be trained to screen for abdominal aortic aneurysms using ultrasound. Cardiovasc Ultrasound 2013; 11:42. [PMID: 24261878 PMCID: PMC3874661 DOI: 10.1186/1476-7120-11-42] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 11/13/2013] [Indexed: 11/26/2022] Open
Abstract
Background Highly trained vascular sonographers make up a significant cost of abdominal aortic aneurysm (AAA) ultrasound screening. However, they are over-trained for this very limited task. Others have reported that health workers (e.g. emergency room staff and nurses) with far less training may be able to perform these scans. The national AAA screening programme in the UK uses staff with limited training. Whether individuals without a health professional qualification could be trained to perform the scan accurately to improve cost-effectiveness is not known. We aimed to investigate whether a short, well-supervised course in ultrasonography could train novices to detect AAA for screening purposes. Methods Three novices were trained by an experienced sonographer for 15 days to perform abdominal aortic ultrasound examinations and detect AAA using a portable ultrasound system. The examination included four anterior-posterior aortic measurements: a maximal diameter in the coronal plane and three diameters of the suprarenal, mid and distal infrarenal aorta in the transverse plane. The novices independently scanned 215 subjects following training; experienced sonographers repeated the measurements on the same subject in the same session. Using Bland-Altman plots and CUSUM analysis, the novices’ and experienced sonographers’ accuracy and efficiency measurements were compared. Factors influencing performance were recorded. Results The novices measured the maximal coronal aortic diameter accurately, to within 0.46-0.52 cm of the true diameter; 85-97% of their coronal measurements were within 0.5 cm of the assessors; kappa statistic and Bland-Altman plots show a high agreement with the assessor’s measurements. However, the novices’ measurements of the three diameters in the transverse plane were outside clinically acceptable limits. Assuming a referral policy for a second scan for scans recorded as 'difficult’, only one novice missed a 3.13 cm aneurysm. A CUSUM quality improvement analysis demonstrated substantial improvements in the scanning efficiency of the novices with continued scanning experience. Conclusion This study showed that novices could be trained to screen for AAA over 15 days. However, the need for continuing quality improvement is critical, especially in more technically demanding cases. Measuring the maximal infrarenal diameter instead of specific segmental diameters may be more appropriate for AAA screening using novices.
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Affiliation(s)
| | | | | | | | - Andre M van Rij
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand.
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Long A, Rouet L, Lindholt J, Allaire E. Measuring the Maximum Diameter of Native Abdominal Aortic Aneurysms: Review and Critical Analysis. Eur J Vasc Endovasc Surg 2012; 43:515-24. [DOI: 10.1016/j.ejvs.2012.01.018] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 01/18/2012] [Indexed: 12/15/2022]
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Yeap BB, Chubb SAP, McCaul KA, Flicker L, Ho KKY, Golledge J, Hankey GJ, Norman PE. Associations of IGF1 and its binding proteins with abdominal aortic aneurysm and aortic diameter in older men. Eur J Endocrinol 2012; 166:191-7. [PMID: 22113073 DOI: 10.1530/eje-11-0725] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Abdominal aortic aneurysm (AAA) is most prevalent in older men. GH secretion declines with age resulting in reduced IGF1 levels. IGF1 and its binding proteins (IGFBPs) are expressed in vasculature, and lower IGF1 levels have been associated with cardiovascular risk factors and disease. However, the relationship of the IGF1 system with aortic dilation and AAA is unclear. We tested the hypothesis that circulating IGF1 and IGFBPs are associated with AAA and aortic diameter in older men. DESIGN A cross-sectional analysis involving 3981 community-dwelling men aged 70-89 years was performed. METHODS Abdominal aortic diameter was measured by ultrasound. Plasma total IGF1, IGFBP1 and IGFBP3 were measured by immunoassays. RESULTS After adjustment for age, body mass index, waist:hip ratio, smoking, hypertension, dyslipidemia, diabetes, coronary heart disease and serum creatinine, a higher IGF1 level was associated with AAA (odds ratio (OR)/1 s.d. increase 1.18, 95% confidence interval (CI) 1.05-1.33, P=0.006), as was the ratio of IGF1/IGFBP3 (OR=1.22, 95% CI 1.10-1.35, P<0.001). Highest IGF1 concentrations compared with lowest quintile were significantly associated with AAA (quintile (Q) 5 vs Q1: OR=1.80, 95% CI 1.20-2.70, P=0.004) as were IGF1/IGFBP3 ratios (Q5 vs Q1: OR=2.52, 95% CI 1.59-4.02, P<0.001). IGF1 and IGFBP1 were independently associated with aortic diameter (β=0.200, 95% CI 0.043-0.357, P=0.012 and β=0.274, 95% CI 0.098-0.449, P=0.002 respectively). CONCLUSIONS In older men, higher IGF1 and an increased ratio of IGF1/IGFBP3 are associated with AAA, while IGFBP1 is independently associated with increased aortic diameter. Components of the IGF1 system may contribute to, or be a marker for, aortic dilation in ageing men.
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Affiliation(s)
- Bu B Yeap
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.
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Badger SA, Jones C, McClements J, Lau LL, Young IS, Patterson CC. Surveillance strategies according to the rate of growth of small abdominal aortic aneurysms. Vasc Med 2011; 16:415-21. [DOI: 10.1177/1358863x11423971] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The management of small abdominal aortic aneurysms (AAA) is by ultrasound surveillance. The study aimed to calculate their growth rate, identify risk factors and determine appropriate screening intervals. The local screening programme and hospital records were used to identify patients with a small (< 5.5 cm) AAA. The dates and maximum diameter of serial scans of patients with two or more scans were obtained. Patients were subdivided by 0.5 cm increments above 3.0 cm. The rate of growth was calculated by linear regression for each patient using both the absolute measurements and logarithmically (ln) transformed measurements. The 95th centile of growth rate within each subgroup was used to estimate the minimum time to grow to 5.5 cm. A total of 252 were included. The mean (± SD) AAA size on the initial scan was 3.9 (± 0.7) cm. Statin use and initial size were predictive factors for the growth rate. The median rate of growth increased according to size from 0.075 to 0.432 cm/year for AAA < 3.5 cm and > 5.0 cm, respectively. It also steadily increased for ln measurements from 0.022 (or 2.2%/year) to 0.078 or (7.8%/year). The minimum time (months) to reach 5.5 cm was 61, 17, 11 and 5 for AAA < 3.5 cm, 3.5–3.9 cm, 4.0–4.4 cm and 4.5–4.9 cm, respectively. Based on ln measurements, the times were similar at 60, 17, 10 and 4 months. In conclusion, the rate of growth increased steadily with AAA size. An aneurysm < 3.5 cm does not require a repeat scan for 5 years, while those measuring 3.5–3.9 cm and 4.0–4.4 cm require a repeat scan after 17 and 11 months.
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Affiliation(s)
- Stephen A Badger
- Vascular and Endovascular Surgery Department, Belfast City Hospital, Belfast, UK
| | - Claire Jones
- Vascular and Endovascular Surgery Department, Belfast City Hospital, Belfast, UK
| | - Jane McClements
- Vascular and Endovascular Surgery Department, Belfast City Hospital, Belfast, UK
| | - Louis L Lau
- Vascular and Endovascular Surgery Department, Belfast City Hospital, Belfast, UK
| | - Ian S Young
- Centre for Public Health, Queens University Belfast, Belfast, UK
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Moll FL, Powell JT, Fraedrich G, Verzini F, Haulon S, Waltham M, van Herwaarden JA, Holt PJE, van Keulen JW, Rantner B, Schlösser FJV, Setacci F, Ricco JB. Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg 2011; 41 Suppl 1:S1-S58. [PMID: 21215940 DOI: 10.1016/j.ejvs.2010.09.011] [Citation(s) in RCA: 996] [Impact Index Per Article: 76.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Accepted: 09/12/2010] [Indexed: 12/11/2022]
Affiliation(s)
- F L Moll
- Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands.
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Park YJ, Kim N, Kim YW. Investigation of Current Trend of AAA Treatment in Korea. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011. [DOI: 10.4174/jkss.2011.80.2.125] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yang Jin Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Nari Kim
- Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Xenos M, Rambhia SH, Alemu Y, Einav S, Labropoulos N, Tassiopoulos A, Ricotta JJ, Bluestein D. Patient-based abdominal aortic aneurysm rupture risk prediction with fluid structure interaction modeling. Ann Biomed Eng 2010; 38:3323-37. [PMID: 20552276 DOI: 10.1007/s10439-010-0094-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Accepted: 06/01/2010] [Indexed: 11/30/2022]
Abstract
Elective repair of abdominal aortic aneurysm (AAA) is warranted when the risk of rupture exceeds that of surgery, and is mostly based on the AAA size as a crude rupture predictor. A methodology based on biomechanical considerations for a reliable patient-specific prediction of AAA risk of rupture is presented. Fluid-structure interaction (FSI) simulations conducted in models reconstructed from CT scans of patients who had contained ruptured AAA (rAAA) predicted the rupture location based on mapping of the stresses developing within the aneurysmal wall, additionally showing that a smaller rAAA presented a higher rupture risk. By providing refined means to estimate the risk of rupture, the methodology may have a major impact on diagnostics and treatment of AAA patients.
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Affiliation(s)
- Michalis Xenos
- Department of Biomedical Engineering, Stony Brook University, HSC T18-030, Stony Brook, NY 11794-8181, USA
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28
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Affiliation(s)
- You Sun Hong
- Department of Thoracic and Cardiovascular Surgery, Ajou University College of Medicine, Korea.
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Schlösser F, Gusberg R, Dardik A, Lin P, Verhagen H, Moll F, Muhs B. Aneurysm Rupture after EVAR: Can the Ultimate Failure be Predicted? Eur J Vasc Endovasc Surg 2009; 37:15-22. [PMID: 19008129 DOI: 10.1016/j.ejvs.2008.10.011] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Accepted: 10/19/2008] [Indexed: 10/21/2022]
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Waterhouse DF, Cahill RA. Simple adaptation of current abdominal aortic aneurysm screening programs may address all-cause cardiovascular mortality: prospective observational cohort study. Am Heart J 2008; 155:938-45. [PMID: 18440345 DOI: 10.1016/j.ahj.2007.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Accepted: 12/11/2007] [Indexed: 01/11/2023]
Abstract
BACKGROUND Population screening for abdominal aortic aneurysm (AAA) can be cost-justified by its impact on the incidence of emergency presentations with rupture. The objective of this prospective, cohort study was to determine whether the proposed framework can be further evolved to address all-cause cardiovascular mortality in the community by integrating full risk factor assessment. METHODS Male volunteers aged >60 years attending for AAA screening by ultrasound also underwent full cardiovascular assessment via physician-administered health questionnaire, sphygmomanometry, anthromorphometry, and fasting phlebotomy for lipid and glucose profiling. Framingham and SCORE project evaluations were used to calculate 10-year risk of ischemic heart disease and all-cause fatal cardiovascular disease, respectively. RESULTS A total of 481 men were screened, and 23 (4.8%) had an AAA detected (22% of which were >4 cm). Obesity, smoking, hypertension, impaired glucose metabolism, and hypercholesterolemia were notably frequent in those without an AAA. Mean 10-year cardiovascular risk in the population without AAA (6.89 and 6.74 by SCORE and Framingham estimations, respectively) was similar to those with AAA (7.78 and 7.04, respectively). Supplementary screening increased total costs by 2.5%. Reserving concomitant atherosclerotic testing for those with elevated systolic blood pressure at presentation allowed identification of 96%/95% of those with Framingham/SCORE risks >10%, respectively, thus saving 162 (33%) individuals from additional investigation and conserving the cost increment to 1.8% overall. CONCLUSION The proven framework of population sifting for AAA provides a unique opportunity to also confront latent cardiovascular malady. Sphygmomanometry during ultrasonographic screening for AAA seems both cost-effective and readily incorporated within the current paradigm.
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Schlösser FJV, Tangelder MJD, Verhagen HJM, van der Heijden GJMG, Muhs BE, van der Graaf Y, Moll FL. Growth predictors and prognosis of small abdominal aortic aneurysms. J Vasc Surg 2008; 47:1127-33. [PMID: 18440183 DOI: 10.1016/j.jvs.2008.01.041] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Revised: 01/13/2008] [Accepted: 01/13/2008] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Evidence regarding the influence of cardiovascular risk factors, comorbidities, and patient characteristics on the growth of small abdominal aortic aneurysms (AAA) is limited. We assessed, in an observational cohort study, rupture rates, risks of mortality, and the effects of cardiovascular risk factors and patient demographics on growth rates of small AAAs. METHODS Between September 1996 and January 2005, 5057 patients with manifest arterial vascular disease or cardiovascular risk factors were included in the Second Manifestation of ARTerial disease (SMART) study. Measurements of the abdominal aortic diameter were performed in all patients. All patients with an initial AAA diameter between 30 and 55 mm were selected for this study. All AAA measurements during follow-up until August 2007 were collected. Multivariate regression analysis was performed to calculate the effects of demographic patient characteristics, initial AAA diameter, and cardiovascular risk factors on AAA growth. RESULTS Included were 230 patients, with a mean age of 66 years and 90% were male. Seven AAA ruptures (six fatal) occurred in 755 patient years of follow-up (rupture rate 0.9% per patient-year). In 147 patients, AAA measurements were performed for a period of more than 6 months. The median follow-up time was 3.3 years (mean 4.0, range 0.5 to 11.1 years, standard deviation (SD) 2.5). Mean AAA diameter was 38.8 mm (SD 6.8) and mean expansion rate 2.5 mm/y. Patients using lipid-lowering drugs had a 1.2 mm/y (95% confidence interval [CI] -2.34 to -0.060 mm/y) lower AAA growth rate compared to nonusers of these drugs. Initial AAA diameter was associated with a 0.09 mm/y (95% CI 0.01 to 0.18 mm/y) higher growth rate per millimetre increase of the diameter. No other factors, including blood lipid values, were independently associated with AAA growth. CONCLUSIONS Lipid-lowering drug treatment and initial AAA diameter appear to be independently associated with lower AAA growth rates. The risk of rupture of these small abdominal aortic aneurysms was low, which pleads for watchful waiting.
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Affiliation(s)
- Felix J V Schlösser
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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32
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Measurement and determinants of infrarenal aortic thrombus volume. Eur Radiol 2008; 18:1987-94. [DOI: 10.1007/s00330-008-0956-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 01/23/2008] [Accepted: 02/16/2008] [Indexed: 10/22/2022]
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Jones GT, Thompson AR, van Bockxmeer FM, Hafez H, Cooper JA, Golledge J, Humphries SE, Norman PE, van Rij AM. Angiotensin II type 1 receptor 1166C polymorphism is associated with abdominal aortic aneurysm in three independent cohorts. Arterioscler Thromb Vasc Biol 2008; 28:764-70. [PMID: 18239157 DOI: 10.1161/atvbaha.107.155564] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Although polymorphic variations in genes of the RAS system have previously been associated with susceptibility to AAA, such studies have been significantly limited by small sample sizes. This study was undertaken, using the largest case series yet reported, to determine whether common genetic variants of the RAS are associated with either susceptibility or severity of AAA. METHODS AND RESULTS The frequencies of 4 common genetic variants of genes related to the renin-angiotensin system were investigated in 3 geographically distinct, but ethnically similar, case-control cohorts, resulting in comparison of 1226 AAA cases with 1723 controls. In all 3 the AGTR1 1166C allele was significantly more common in AAA patients than controls (overall adjusted OR 1.60, 95% CI 1.32 to 1.93, P=1.1x10(-6)). Overall, the ACE ID genotype was associated with AAA (OR 1.33, 95% CI 1.06 to 1.67, P<0.02). The AGT 268T allele appeared to have an epistatic effect on large aneurysm size. CONCLUSIONS This study has identified a strong and repeated association between the AGTR1 1166C allele and susceptibility to AAA, and a weaker effect associated with the ACE deletion allele, in 3 geographically distinct, but ethnically similar, case-control cohorts. This study highlights the key role of the RAS in AAA and emphasizes the need for replication and validation of results in suitable independent cohorts.
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Hobbs SD, Sam RC, Bhatti A, Rehman A, Wilmink AB, Adam DJ, Bradbury AW. The Low Incidence of Surgery for Non-Cardiac Vascular Disease in UK Asians may be Explained by a Low Prevalence of Disease. Eur J Vasc Endovasc Surg 2006; 32:494-9. [PMID: 16679039 DOI: 10.1016/j.ejvs.2006.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2006] [Accepted: 03/11/2006] [Indexed: 01/10/2023]
Abstract
AIMS Firstly, to compare rates of surgery for non-cardiac vascular disease in Caucasians and Asians and secondarily to assess the prevalence of peripheral arterial disease (PAD) and abdominal aortic aneurysm (AAA) in the male UK Asian population. METHODS Analysis of a prospective database followed by an epidemiological survey of 100 unselected Pakistani males, in which demographic and anthropometric data were collected alongside aortic ultrasonography and measurement of ankle: brachial pressure index (ABPI). RESULTS Although 14.1% of our catchment area is Asian, after correction for age, they only accounted for 64/2268 (2.8%) of procedures for PAD and AAA. Specifically, Asians were 10 times less likely to undergo AAA repair and 3 times less likely to undergo procedures for lower limb peripheral bypass, amputation and endovascular intervention. In the epidemiological study, 26 subjects had a significant history of ischaemic heart disease, 21 were diabetic, 32 had hypertension and 60 were current or ex-smokers. Median aortic diameter [IQR] was 17.6 mm [16.3-19.1 mm] and no subject had an AAA. In 200 limbs, median ABPI [IQR] was 1.12 [1.04-1.21]. Only 2 patients had an ABPI < 0.9. CONCLUSION Despite a high prevalence of cardiovascular risk factors and ischaemic heart disease, the prevalence of PAD and AAA is much lower than would have been expected in an age- and sex-matched Caucasian population. These data suggest that the reduced incidence of surgery for PAD and AAA in UK Asians is due to a low prevalence of disease.
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Affiliation(s)
- S D Hobbs
- University Department of Vascular Surgery, Heart of England NHS Foundation Trust, Birmingham, UK
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35
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Wilmink T, Claridge MWC, Fries A, Will O, Hubbard CS, Adam DJ, Quick CRG, Bradbury AW. A Comparison Between the Short Term and Long Term Benefits of Screening for Abdominal Aortic Aneurysms from the Huntingdon Aneurysm Screening Programme. Eur J Vasc Endovasc Surg 2006; 32:16-20. [PMID: 16466938 DOI: 10.1016/j.ejvs.2005.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2005] [Accepted: 12/19/2005] [Indexed: 11/16/2022]
Abstract
BACKGROUND The UK Multicentre Aneurysm Screening Study (MASS) showed a 44% reduction in AAA-related mortality after 4 years and predicted an increased number of deaths prevented in the longer term. We aim to compare the 5 and 13 years benefit from aneurysm screening in the Huntingdon Aneurysm screening programme. METHODS Incidence and mortality of ruptured AAA (RAAA) after 5 and 13 years of screening in a population based aneurysm screening program. RESULTS Five years of screening resulted in a reduction in the incidence of RAAA of 49% (95% CI: 3-74%). Nine out of 11 ruptures in the invited group did not survive (mortality 82%; 95% CI: 48-98%) compared to 38 non-survivors from 51 ruptures in the control group (mortality 75%; 95% CI: 60-86%). Five years of screening resulted in an RAAA-related mortality reduction of 45% (95% CI: -15 to 74%). After 13 years of screening the incidence of RAAA was reduced by 73% (95% CI: 58-82%). Twenty-one out of 29 ruptures in the invited group did not survive (mortality 72%; 95% CI: 53-87%) compared to 64 non-survivors from 82 ruptures in the control group (mortality 78%; 95% CI: 68-86%). Thirteen years screening resulted in a reduction of mortality from RAAA of 75% (95% CI: 58-84%). The number needed to screen to prevent one death reduced from 1380 after 5 years to 505 after 13 years. The number of elective AAA operations needed to prevent one death reduced from 6 after 5 years to 4 after 13 years. CONCLUSION AAA screening becomes increasingly beneficial as screening continues over the longer term. Benefits continue to increase after screening has ceased.
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Affiliation(s)
- T Wilmink
- University Department of Vascular Surgery, Research Institute, Birmingham Heartlands Hospital, Birmingham, UK.
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36
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Waterhouse DF, Cahill RA, Sheehan F, Sheehan SJ. Concomitant Detection of Systemic Atherosclerotic Disease while Screening for Abdominal Aortic Aneurysm. World J Surg 2006; 30:1350-9. [PMID: 16773254 DOI: 10.1007/s00268-005-0604-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Although population screening for abdominal aortic aneurysm (AAA) has/had a significant impact on disease-specific mortality, coexisting systemic atherosclerosis represents the major impediment to improved longevity. We examined the feasibility and yield of full cardiovascular assessment concomitant with screening for AAA detection. METHODS A total of 1032 asymptomatic men over the age of 50 years (328 were >60 years) underwent a detailed cardiac health questionnaire, sphygmomanometry, body mass index calculation, fasting lipid profiling, ultrasonographic (US) examination of their infrarenal aorta and carotid arteries, and treadmill exercise stress testing. Framingham and SCORE project estimations of the 10-year risk of ischemic heart disease (IHD) and fatal cardiovascular disease (CVD) of any cause were calculated for the men with an AAA and in those>60 years but with neither AAA nor known cardiac disease. RESULTS Overall, we detected an AAA>3 cm in 30 men (2.9%). Unaddressed obesity, smoking, hypertension, impaired glucose metabolism, and hypercholesterolemia were commonly identified in individuals both with and without an AAA, being notably frequent in those>60 years without an AAA. The 10-year risk of IHD and CHD in those>60 years was similar regardless of whether an AAA was present. Doppler screening for significant carotid stenosis had detection rates similar to those for aortic US scanning, being most useful in those>65 years of age. Exercise stress testing, however, was of only limited value when used nonselectively. CONCLUSIONS Modifiable atherosclerotic disease and cardiovascular risk can be readily detected in individuals presenting for AAA screening and are present to a significant degree at an earlier age. Consideration of selected, additional investigations is required to maximize the value of generalized screening programs.
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Affiliation(s)
- D F Waterhouse
- Department of Vascular Medicine, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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Silverstein MD, Pitts SR, Chaikof EL, Ballard DJ. Abdominal aortic aneurysm (AAA): cost-effectiveness of screening, surveillance of intermediate-sized AAA, and management of symptomatic AAA. Proc AMIA Symp 2005; 18:345-67. [PMID: 16252027 PMCID: PMC1255946 DOI: 10.1080/08998280.2005.11928095] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Physicians must make decisions about screening patients for abdominal aortic aneurysms (AAAs), monitoring or referring for surgery patients with AAAs of various sizes, and assessing patients with symptoms that may be related to AAAs. This review article analyzes the evidence for each scenario. The effectiveness and cost-effectiveness of screening for AAA is based on results from four randomized controlled trials. A cost-effectiveness analysis using a Markov model showed that ultrasound screening of white men beginning at age 65 is both effective and cost-effective in preventing AAA-related death. Such screening would have a small but real impact over a 20-year period in these men. For patients with a known AAA-which is often detected incidentally-the evidence clearly suggests periodic ultrasound surveillance for those with small AAAs (3.0-3.9 cm in diameter) and elective surgical repair for those with large AAAs (>or=5.5 cm). Two recent randomized controlled trials have shown that early surgical repair confers no survival benefit compared with periodic surveillance for patients with intermediate-sized AAAs (4.0-5.5 cm in diameter), so those patients can also be monitored. Some centers choose to increase the frequency of monitoring to every 3 to 6 months when the AAA reaches 5.0 cm. Factors to consider in assessing symptomatic patients include the high risk of life-threatening conditions, the potential increased risk of death or poor outcome with delay in diagnosis, the limitations of ultrasound in identifying whether symptoms are due to known or suspected AAA, and the timely availability of computed tomography or other imaging tests. If available, computed tomography is preferred in patients with recent or severe symptoms, since it is better at detecting retroperitoneal hemorrhage and other complications and in providing preoperative definition of the anatomy.
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Affiliation(s)
- Marc D. Silverstein
- From HealthTexas Provider Network, Dallas, Texas (Silverstein); Department of Emergency Medicine, Emory University School of Medicine, and Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia (Pitts); Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia (Chaikof); and Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, Texas (Ballard, Silverstein)
| | - Stephen R. Pitts
- From HealthTexas Provider Network, Dallas, Texas (Silverstein); Department of Emergency Medicine, Emory University School of Medicine, and Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia (Pitts); Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia (Chaikof); and Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, Texas (Ballard, Silverstein)
| | - Elliot L. Chaikof
- From HealthTexas Provider Network, Dallas, Texas (Silverstein); Department of Emergency Medicine, Emory University School of Medicine, and Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia (Pitts); Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia (Chaikof); and Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, Texas (Ballard, Silverstein)
| | - David J. Ballard
- From HealthTexas Provider Network, Dallas, Texas (Silverstein); Department of Emergency Medicine, Emory University School of Medicine, and Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia (Pitts); Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia (Chaikof); and Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, Texas (Ballard, Silverstein)
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Kuzmanović IB, Davidović LB, Kostić DM, Maksimović ZL, Cinara IS, Svetković SD, Marković DM, Moarković MM, Krstić N, Koncar IB. [Long-term results after elective and emergency surgery of abdominal aortic aneurysm]. SRP ARK CELOK LEK 2005; 132:306-12. [PMID: 15794051 DOI: 10.2298/sarh0410306k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Abdominal aortic aneurysm can be repaired by elective procedure while asymptomatic, or immediately when it is complicated--mostly due to rupture. Treating abdominal aneurysm electively, before it becomes urgent, has medical and economical reason. Today, the first month mortality after elective operations of the abdominal aorta aneurysm is less than 3%; on the other hand, significant mortality (25%-70%) has been recorded in patients operated immediately because of rupture of the abdominal aneurysm. In addition, the costs of elective surgical treatment are significantly lower. OBJECTIVE The objective of this study is to compare long-term survival of patients that underwent elective or immediate repair of abdominal aortic aneurysm (due to rupture), and to find out the factors influencing the long-term survival of these patients. MATERIAL AND METHODS Through retrospective review of prospectively collected data of the Institute for Cardiovascular Diseases of Clinical Center of Serbia, Belgrade, 56 patients that had elective surgery and 35 patients that underwent urgent operation due to rupture of abdominal aneurysm were followed up. Only the patients that survived 30 postoperative days were included in this review, and-were followed up (ranging from 2 to 126 months). Electively operated patients were followed during 58.82 months on the average (range 7 to 122), and urgently operated were followed over 52.26 months (range 2 to 126). There was no significant difference of the length of postoperative follow-up between these two groups. RESULTS During this period, out of electively operated and immediately operated patients, 27 and 22 cases died, respectively. There was no significant difference (p>0.05a) of long-term survival between these two groups. Obesity and early postoperative complications significantly decreased long-term survival of both electively and immediately operated patients. Graft infection, ventral hernia, aneurysm of peripheral arteries and other vascular reconstructive procedures were the factors that significantly reduced long-term survival of patients operated immediately due to rupture. DISCUSSION This comprehensive study has searched for more factors than others had done before. The applied discriminative analysis numerically evaluated the influence of any risk factor of mortality. These factors were divided in three groups as follows: preoperative, operative and postoperative ones. Preoperative factors were sex, age, diabetes mellitus, arterial hypertension, obesity, COPD, and naturally, the indication for operative treatment of ruptured or non-ruptured abdominal aneurysm. Among all these factors, only obesity significantly reduced long-term survival of electively operated patients. It may be said that immediately operated patients who survived the first 30 postoperative days had quite good long-term survival. Operative factors such as type of operative procedure and vascular graft had no influence on long-term survival of patients in both groups. Postoperative risk factors were early postoperative complications, graft infection, symptomatic cerebrovascular disease, carotid endarterectomy, myocardial revascularization, ventral hernias, "other" non vascular operations, malignancy, mental disorders, peripheral aneurysms and occlusive vascular disease, and other vascular operations either due to aneurysm or peripheral occlusive disease. Early postoperative complications (even graft infection) had no significant effect on long-term survival. Ventral hernias and peripheral aneurysms were factors that significantly decreased long-term survival of patients operated for rupture of the abdominal aneurysm. CONCLUSION It is interesting that endarterectomy, myocardial revascularization or malignancy after repair of the abdominal aneurysm (ruptured or non-ruptured) had no effect on long-term survival.
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Norman P, Spencer CA, Lawrence-Brown MM, Jamrozik K. C-reactive protein levels and the expansion of screen-detected abdominal aortic aneurysms in men. Circulation 2004; 110:862-6. [PMID: 15302791 DOI: 10.1161/01.cir.0000138746.14425.00] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND C-reactive protein (CRP) levels have been shown to predict a number of cardiovascular outcomes. CRP levels have also been found to be elevated in patients with abdominal aortic aneurysms (AAAs). The aim of this study was to assess the relation between CRP levels and rates of expansion of small AAAs. METHODS AND RESULTS A cohort of men with small aneurysms was identified in a trial of screening with ultrasound scanning. After initial screening, men were rescanned at 6- to 12-month intervals. CRP levels were measured at the first follow-up visit. Rates of expansion and risk factors for expansion were assessed with the use of data from 545 men who attended for at least 1 scan after CRP levels were measured. These men were followed for a median of 48 (range, 5 to 69) months. The mean annual rate of expansion was 1.6 mm. The median CRP level was 2.6 mg/L in men with the smaller AAAs (30 to 39 mm, n=433) compared with 3.5 mg/L in men with larger AAAs (40 to 54 mm, n=112) (P=0.007). The multivariate age-adjusted logistic model confirmed initial aortic diameter to be the only factor associated with rapid expansion with an odds ratio of 7.2 (95% CI, 4.3,12.2) for an initial diameter of 40 to 54 mm relative to one of 30 to 39 mm. CONCLUSIONS Most small aneurysms expand slowly. CRP levels are elevated in larger aneurysms but do not appear to be associated with rapid expansion. The most useful predictor of aneurysmal expansion in men is aortic diameter.
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Affiliation(s)
- Paul Norman
- School of Surgery and Pathology, The University of Western Australia, Fremantle Hospital, Fremantle, Western Australia.
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Norman P, Le M, Pearce C, Jamrozik K. Infrarenal Aortic Diameter Predicts All-Cause Mortality. Arterioscler Thromb Vasc Biol 2004; 24:1278-82. [PMID: 15130915 DOI: 10.1161/01.atv.0000131261.12051.7f] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
To assess the relationship between infrarenal aortic diameter and subsequent all-cause mortality in men aged 65 years or older.
Methods and Results—
Aortic diameter was measured using ultrasound in 12 203 men aged 65 to 83 years as part of a trial of screening for abdominal aortic aneurysms. A range of cardiovascular risk factors was also documented. Mortality over the next 3 to 7 years was assessed using record linkage. Initial aortic diameter was categorized into 10 intervals, and the relationship between increasing diameter and subsequent mortality was explored using Cox proportional hazard models. Median diameter increased from 21.4 mm in the youngest men to 22.1 mm in the oldest men. The cumulative all-cause mortality increased in a graded fashion with increasing aortic diameter. Using the diameter interval 19 to 22 mm as the reference, the adjusted hazard ratio for all-cause mortality increased from 1.26 (95% CI: 1.09, 1.44;
P
=0.001) for aortic diameters of 23 to 26 mm to 2.38 (95% CI: 1.22, 4.61;
P
=0.011) for aortic diameters of 47 to 50 mm. Analysis of causes of death indicated that cardiovascular disease was an important contributor to this increase.
Conclusion—
Infrarenal aortic diameter is an independent marker of subsequent all-cause mortality.
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Affiliation(s)
- Paul Norman
- School of Surgery and Pathology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia.
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Shakibaie F, Hall JC, Norman PE. Indications for operative management of abdominal aortic aneurysms. ANZ J Surg 2004; 74:470-6. [PMID: 15191485 DOI: 10.1111/j.1445-1433.2004.03033.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The increasing incidence of abdominal aortic aneurysms, along with the more frequent use of screening techniques, has resulted in greater numbers of patients with small abdominal aortic aneurysms. The questions of frequency of surveillance and timing of intervention are the two most controversial issues faced by surgeons dealing with this condition. Most management decisions are based on the size of the aneurysm but other factors must also be considered. This review makes recommendations on the management of small abdominal aortic aneurysms according to the current available evidence.
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Affiliation(s)
- Faraz Shakibaie
- School of Surgery and Pathology, The University of Western Australia, Perth, Western Australia, Australia
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Civeira F. Guidelines for the diagnosis and management of heterozygous familial hypercholesterolemia. Atherosclerosis 2004; 173:55-68. [PMID: 15177124 DOI: 10.1016/j.atherosclerosis.2003.11.010] [Citation(s) in RCA: 330] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2003] [Revised: 09/08/2003] [Accepted: 11/05/2003] [Indexed: 10/26/2022]
Abstract
Familial hypercholesterolemia (FH) is a genetic disorder of lipoprotein metabolism characterized by very high plasma concentrations of low density lipoprotein cholesterol (LDLc), tendon xanthomas and increased risk of premature coronary heart disease (CHD). FH is a public health problem throughout the world. There are 10,000,000 people with FH worldwide, mainly heterozygotes, and approximately 85% of males and 50% of females with FH will suffer a coronary event before 65 years old if appropriate preventive efforts are not implemented. Early identification of persons with FH and their relatives, and the early start of treatment are essential issues in the prevention of premature cardiovascular disease (CVD) and death in this population. However, guidelines for the general population formally exclude FH from their diagnostic and treatment recommendations. These guidelines have been elaborated by a group of international experts with the intention to answer the main questions about heterozygous FH (heFH) subjects that physicians worldwide face in the diagnosis and management of these patients.
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Affiliation(s)
- Fernando Civeira
- Lipid Unit, Hospital Universitario Miguel Servet, Avda Isabel La Católica 1-3, 50009 Zaragoza, Spain.
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Spencer C, Jamrozik K, Kelly S, Bremner P, Norman P. Is there an association between chronic lung disease and abdominal aortic aneurysm expansion? ANZ J Surg 2003; 73:787-9. [PMID: 14525566 DOI: 10.1046/j.1445-2197.2003.02796.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although there is evidence demonstrating an association between chronic obstructive pulmonary disease (COPD) and abdominal aortic aneurysm (AAA), it is not clear whether COPD predicts greater rates of expansion of established aneurysms. We sought such an association in a cohort of men with aneurysms detected in a population-based study of screening for aneurysms. METHODS In addition to regular aortic ultrasound scans, 179 men with AAA underwent full lung function testing in order to identify the presence of COPD and its subgroups, emphysema and other obstructive ventilatory defects (OVD). The rate of expansion of each aneurysm was calculated and the men were divided into 'rapid expanders' (3 mm or more per year) and 'slow expanders' (less than 3 mm per year). Any association with the presence of COPD or smoking was tested using a multivariate model. RESULTS Over a median follow-up period of 36 months the mean rate of aortic expansion for the cohort of 179 men was 2.1 mm/year. There was no significant difference in prevalence of COPD (68% overall) or having ever been a smoker (87% overall) between the rapid expanders and the slow expanders. CONCLUSIONS Although there was a high prevalence of COPD among men with an AAA, there was no association between the rate of expansion of AAA and the presence of any form of this disease.
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Affiliation(s)
- Carole Spencer
- School of Population Health, The University of Western Australia, Nedlands, Western Australia, Australia.
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van Vlijmen-van Keulen CJ, Pals G, Rauwerda JA. Familial abdominal aortic aneurysm: a systematic review of a genetic background. Eur J Vasc Endovasc Surg 2002; 24:105-16. [PMID: 12389231 DOI: 10.1053/ejvs.2002.1692] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Familial clustering of the abdominal aortic aneurysm (AAA) is clear, 12-19% of AAA patients have one or more first-degree relatives with an aneurysm and 4-19% is detected with ultrasound screening. OBJECTIVES To review the genetic background of AAA. DESIGN, METHODS AND MATERIALS: Computer searches of the MEDLINE, EMBASE, SUMsearch database and the Cochrane Library and searched reference lists of English language articles concerning the genetics of AAA, candidate gene approach and linkage analysis. RESULTS Brothers of AAA patients are at high risk to develop an AAA. The candidate gene approach was performed to detect defects in one of the components of the connective tissue, i.e. type I and III collagen, elastin and fibrillin, the inflammatory cell-derived matrix metalloproteinase, there inhibitors, auto-immune components and components related to atherosclerosis. CONCLUSION These studies give us insight in the pathology but do not lead to the specific genetic factor(s) responsible for (familial) AAA. Considering the supposed autosomal dominant inheritance, a gene mutation in one of the structural proteins of the connective tissue is expected. In the future, linkage analysis may resolve the genetic background of AAA.
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