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Mensel B, Mahnken AH, Kaiser E, Völzke H, Dörr M, Felix SB, Ittermann T, Lieb W, Lorbeer R. Association of aortic diameters and mortality in the general population-an MRI-based study. Eur Radiol 2024:10.1007/s00330-024-10965-4. [PMID: 39026062 DOI: 10.1007/s00330-024-10965-4] [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: 05/13/2024] [Revised: 06/03/2024] [Accepted: 07/03/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Increased diameters of the aorta are associated with increased mortality risk. In the present analyses, we assessed whether aortic diameters are associated with cardiovascular and all-cause mortality in community-dwelling individuals free of known cardiovascular disease (CVD). METHODS MRI-derived vascular parameters of the thoracic and abdominal aorta from 2668 participants (median age = 53 years; 51.1% women) of the population-based SHIP-START-2 and SHIP-TREND-0 cohorts without CVD were analyzed. Age- and sex-adjusted, as well as multivariable-adjusted Cox-proportional hazard models, were used to estimate associations of diameters of six different aortic segments to mortality. RESULTS Over a median follow-up time of 10.6 years (IQR: 8.7; 12.4), a total of 188 participants (126 men and 62 women) died, of which 38 deaths were due to CVD. In unadjusted models, mortality rates were higher in participants with aortic diameters above the median compared to below the median for all investigated aortic sections (all log-rank p < 0.001). In multivariable-adjusted models, the diameters of the ascending thoracic aorta (HR = 1.34 95% CI: 1.04; 1.72, p = 0.022) and of the infrarenal aorta (HR = 3.75 95% CI: 1.06; 13.3, p = 0.040), modeled continuously, were associated with greater cardiovascular mortality. The diameter of the subphrenic aorta was associated with higher cardiovascular mortality only in the age and sex-adjusted model (HR = 3.65 95% CI: 1.01; 13.3, p = 0.049). None of the investigated aortic segments were associated with all-cause mortality. CONCLUSION Non-indexed diameters of the ascending thoracic and infrarenal aorta were associated with higher cardiovascular mortality but not with all-cause mortality in a population sample free of clinically overt CVD at baseline. CLINICAL RELEVANCE STATEMENT Increased aortic diameter is associated with cardiovascular mortality and can help to identify high-risk patients. KEY POINTS Increased aortic diameter is associated with mortality. Non-indexed diameters of the ascending and infrarenal aorta are associated with cardiovascular mortality but not all-cause mortality. Aortic diameter measurements support the estimate of cardiovascular mortality.
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Affiliation(s)
- Birger Mensel
- Department of Diagnostic & Interventional Radiology, Philipps-University Marburg, Marburg, Germany.
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Central Hospital Bad Berka, Bad Berka, Germany.
| | - Andreas H Mahnken
- Department of Diagnostic & Interventional Radiology, Philipps-University Marburg, Marburg, Germany
| | - Erhard Kaiser
- Department of Diagnostic & Interventional Radiology, Philipps-University Marburg, Marburg, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK e.V.), Partner Site Greifswald, Greifswald, Germany
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK e.V.), Partner Site Greifswald, Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Kiel University, Kiel, Germany
| | - Roberto Lorbeer
- Department of Radiology, University Hospital LMU Munich, Munich, Germany
- German Centre for Cardiovascular Research (DZHK e.V.), Partner Site Munich Heart Alliance, Munich, Germany
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Craiem D, Guilenea F, de Freminville JB, Azizi M, Casciaro ME, Gencer U, Jannot AS, Amar L, Soulat G, Mousseaux E. Abdominal aortic calcium and geometry in patients with essential hypertension. Diagn Interv Imaging 2024; 105:174-182. [PMID: 38148259 DOI: 10.1016/j.diii.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/20/2023] [Accepted: 12/13/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE Abdominal aorta calcium (AAC) burden and dilatation are associated with an increased risk of mortality. The purpose of this study was to investigate determinants of AAC and abdominal aorta size in patients with essential hypertension. MATERIALS AND METHODS Patients with uncomplicated essential hypertension who had undergone non-enhanced abdominal CT to rule out secondary hypertension in addition to biological test were recruited between 2010 and 2018. A semi-automatic system was designed to estimate the aortic size (diameter, length, volume) and quantify the AAC from mesenteric artery to bifurcation using the Agatston score. Determinants of aortic size and those related to AAC were searched for using uni- and multivariables analyses. RESULTS Among 293 randomly selected patients with hypertension (age 52 ± 11 [SD] years) included, 23% had resistant hypertension. Mean abdominal aorta diameter was 20.1 ± 2.1 (SD) mm. Eight (3%) patients had abdominal aorta aneurysm ≥ 30 mm and 58 (20%) had dilated abdominal aorta ≥ 27 mm. Median AAC score was 38 and calcifications were detected in the infra- and supra-renal abdominal aortic portions in 59% and 26% of the patients, respectively. After adjustment for age, male sex and body surface area, abdominal aorta diameter was positively associated with diastolic blood pressure (P = 0.0019). Smoking was the single variable associated with calcified abdominal aorta (P < 0.001) after adjustment for cofactors. In patients with calcifications of abdominal aorta, the score increased with smoking history (P < 0.001), statins treatment (P < 0.01), greater number of anti-hypertensive drugs (P < 0.01), larger abdominal aorta (P < 0.05) and greater systolic blood pressure (P < 0.05). Patients with resistant hypertension had more AAC in the supra-renal abdominal aorta portion than those without resistant hypertension (P < 0.01). CONCLUSION In patients with essential hypertension, abdominal aorta dilation is related with diastolic blood pressure while AAC is associated with smoking history and resistant hypertension when located to the supra-renal abdominal aorta portion.
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Affiliation(s)
- Damian Craiem
- Instituto de Medecina Traslacional, Trasplante y Bioingenieria (IMeTTyB), Universidad Favaloro-CONICET, CP1078 Buenos Aires, Argentina
| | - Federico Guilenea
- Instituto de Medecina Traslacional, Trasplante y Bioingenieria (IMeTTyB), Universidad Favaloro-CONICET, CP1078 Buenos Aires, Argentina
| | - Jean-Batiste de Freminville
- AP-HP, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, 75015 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Michel Azizi
- AP-HP, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, 75015 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Mariano E Casciaro
- Instituto de Medecina Traslacional, Trasplante y Bioingenieria (IMeTTyB), Universidad Favaloro-CONICET, CP1078 Buenos Aires, Argentina
| | - Umit Gencer
- AP-HP, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, 75015 Paris, France
| | - Anne-Sophie Jannot
- AP-HP, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, 75015 Paris, France
| | - Laurence Amar
- AP-HP, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, 75015 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Gilles Soulat
- AP-HP, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, 75015 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Elie Mousseaux
- AP-HP, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, 75015 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France.
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Bianchini E, Lønnebakken MT, Wohlfahrt P, Piskin S, Terentes‐Printzios D, Alastruey J, Guala A. Magnetic Resonance Imaging and Computed Tomography for the Noninvasive Assessment of Arterial Aging: A Review by the VascAgeNet COST Action. J Am Heart Assoc 2023; 12:e027414. [PMID: 37183857 PMCID: PMC10227315 DOI: 10.1161/jaha.122.027414] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Magnetic resonance imaging and computed tomography allow the characterization of arterial state and function with high confidence and thus play a key role in the understanding of arterial aging and its translation into the clinic. Decades of research into the development of innovative imaging sequences and image analysis techniques have led to the identification of a large number of potential biomarkers, some bringing improvement in basic science, others in clinical practice. Nonetheless, the complexity of some of these biomarkers and the image analysis techniques required for their computation hamper their widespread use. In this narrative review, current biomarkers related to aging of the aorta, their founding principles, the sequence, and postprocessing required, and their predictive values for cardiovascular events are summarized. For each biomarker a summary of reference values and reproducibility studies and limitations is provided. The present review, developed in the COST Action VascAgeNet, aims to guide clinicians and technical researchers in the critical understanding of the possibilities offered by these advanced imaging modalities for studying the state and function of the aorta, and their possible clinically relevant relationships with aging.
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Affiliation(s)
| | - Mai Tone Lønnebakken
- Department of Clinical ScienceUniversity of BergenBergenNorway
- Department of Heart DiseaseHaukeland University HospitalBergenNorway
| | - Peter Wohlfahrt
- Department of Preventive CardiologyInstitute for Clinical and Experimental MedicinePragueCzech Republic
- Centre for Cardiovascular PreventionCharles University Medical School I and Thomayer HospitalPragueCzech Republic
- Department of Medicine IICharles University in Prague, First Faculty of MedicinePragueCzech Republic
| | - Senol Piskin
- Department of Mechanical Engineering, Faculty of Engineering and Natural SciencesIstinye UniversityIstanbulTurkey
- Modeling, Simulation and Extended Reality LaboratoryIstinye UniversityIstanbulTurkey
| | - Dimitrios Terentes‐Printzios
- First Department of Cardiology, Hippokration Hospital, Athens Medical SchoolNational and Kapodistrian University of AthensGreece
| | - Jordi Alastruey
- School of Biomedical Engineering and Imaging SciencesKing’s College LondonLondonUK
| | - Andrea Guala
- Vall d’Hebron Institut de Recerca (VHIR)BarcelonaSpain
- CIBER‐CV, Instituto de Salud Carlos IIIMadridSpain
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Editor's Choice - Systematic Review and Meta-Analysis of Normal Infrarenal Aortic Diameter in the General Worldwide Population and Changes in Recent Decades. Eur J Vasc Endovasc Surg 2022; 64:4-14. [PMID: 35483578 DOI: 10.1016/j.ejvs.2022.04.014] [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: 09/08/2021] [Revised: 03/19/2022] [Accepted: 04/14/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To analyse the characteristics of normal infrarenal aortic diameter (AD) in the general worldwide population, to examine changes over time, and to investigate geographical differences. DATA SOURCES PubMed, Cochrane Library, and Web of Science. REVIEW METHODS This was a systematic review and meta-analysis of studies published up to October 2020 describing infrarenal AD measured by ultrasound in the general adult population. The study was conducted in accordance with the PRISMA statement and placed no restrictions on geographical location or year of publication. Studies of individuals pre-selected for certain diseases or risk factors and opportunistic screening were excluded. A random effects model was used to estimate pooled mean AD, and meta-regression analysis was used to study the effects of determinants of AD. RESULTS Thirty-two studies were included, reporting data for 941 144 individuals (98% were men). The pooled mean AD was 19.4 mm (95% confidence interval [CI] 18.8 - 20.1), being 20.1 mm (95% CI 19.4 - 20.8) in men and 17.8 mm (95% CI 16.5 - 19.1) in women (p < .001). Outer edge to outer edge (OTO) caliper placement method (p = .015) and body surface area (BSA; p = .010) were significantly associated with larger AD. In men, the largest mean AD was observed in Oceania (p < .001) and the smallest in Asia (p < .020). As none of the studies collected data between 2002 and 2007, the studies were divided into two periods: 2001 and before, and 2008 and after. All recent studies were European, with the diameters being significantly smaller (p = .003) in the latter period (18.3 mm [95% CI 17.5 - 19.1] vs. 20.7 mm [95% CI 19.1 - 22.3]). In the meta-regression models, the reduction in AD over time remained significant after adjustment for potential effect modifiers such as sex, age, geographical area, body size, cardiovascular risk factors, and ultrasound method. CONCLUSION Mean infrarenal AD in older European adults has decreased significantly in recent decades. Male sex, BSA, and OTO ultrasound measurement method are associated with larger AD, and geographical differences were observed in men.
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5
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Chen T, Yang X, Fang X, Tang L, Zhang Y, Weng Y, Zhang H, Wu J, Mao P, Xu B, Jiang J, Chen X. Potential influencing factors of aortic diameter at specific segments in population with cardiovascular risk. BMC Cardiovasc Disord 2022; 22:32. [PMID: 35120453 PMCID: PMC8817600 DOI: 10.1186/s12872-022-02479-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 01/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Aortic diameter is a critical parameter for the diagnosis of aortic dilated diseases. Aortic dilation has some common risk factors with cardiovascular diseases. This study aimed to investigate potential influence of traditional cardiovascular risk factors and the measures of subclinical atherosclerosis on aortic diameter of specific segments among adults. Methods Four hundred and eight patients with cardiovascular risk factors were prospectively recruited in the observational study. Comprehensive transthoracic M-mode, 2-dimensional Doppler echocardiographic studies were performed using commercial and clinical diagnostic ultrasonography techniques. The aortic dimensions were assessed at different levels: (1) the annulus, (2) the mid-point of the sinuses of Valsalva, (3) the sinotubular junction, (4) the ascending aorta at the level of its largest diameter, (5) the transverse arch (including proximal arch, mid arch, distal arch), (6) the descending aorta posterior to the left atrium, and (7) the abdominal aorta just distal to the origin of the renal arteries. Multivariable linear regression analysis was used for evaluating aortic diameter-related risk factors, including common cardiovascular risk factors, co-morbidities, subclinical atherosclerosis, lipid profile, and hematological parameters. Results Significant univariate relations were found between aortic diameter of different levels and most traditional cardiovascular risk factors. Carotid intima-media thickness was significantly correlated with diameter of descending and abdominal aorta. Multivariate linear regression showed potential effects of age, sex, body surface area and some other cardiovascular risk factors on aortic diameter enlargement. Among them, high-density lipoprotein cholesterol had a significantly positive effect on the diameter of ascending and abdominal aorta. Diastolic blood pressure was observed for the positive associations with diameters of five thoracic aortic segments, while systolic blood pressure was only independently related to mid arch diameter. Conclusion Aortic segmental diameters were associated with diastolic blood pressure, high-density lipoprotein cholesterol, atherosclerosis diseases and other traditional cardiovascular risk factors, and some determinants still need to be clarified for a better understanding of aortic dilation diseases.
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Affiliation(s)
- Tingting Chen
- Department of Cardiology, Zhejiang Hospital, Hangzhou, 310013, Zhejiang Province, China
| | - Xingan Yang
- Department of Ultrasonic, Taizhou Hospital Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang Province, China
| | - Xiaoxin Fang
- Department of Cardiology, Taizhou Hospital, Zhejiang University School of Medicine, Hangzhou, 310013, Zhejiang Province, China
| | - Lijiang Tang
- Department of Cardiology, Zhejiang Hospital, Hangzhou, 310013, Zhejiang Province, China
| | - Yang Zhang
- Department of Cardiology, Taizhou Hospital Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang Province, China.,Laboratory of Cardiovascular Disease, Taizhou Hospital Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang Province, China
| | - Yingzheng Weng
- Department of Cardiology, Zhejiang Hospital, Hangzhou, 310013, Zhejiang Province, China
| | - Hongliang Zhang
- Department of Cardiology, Taizhou Hospital Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang Province, China.,Laboratory of Cardiovascular Disease, Taizhou Hospital Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang Province, China
| | - Juntao Wu
- Department of Cardiology, Taizhou Hospital Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang Province, China.,Laboratory of Cardiovascular Disease, Taizhou Hospital Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang Province, China
| | - Ping Mao
- Department of Cardiology, Zhejiang Hospital, Hangzhou, 310013, Zhejiang Province, China
| | - Baohui Xu
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Jianjun Jiang
- Department of Cardiology, Taizhou Hospital Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang Province, China.,Laboratory of Cardiovascular Disease, Taizhou Hospital Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang Province, China
| | - Xiaofeng Chen
- Department of Cardiology, Taizhou Hospital Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang Province, China. .,Laboratory of Cardiovascular Disease, Taizhou Hospital Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang Province, China. .,Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
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6
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Golledge J, Velu R, Quigley F, Jenkins J, Singh TP. Editor's Choice - Cohort Study Examining the Association Between Abdominal Aortic Size and Major Adverse Cardiovascular Events in Patients with Aortic and Peripheral Occlusive and Aneurysmal Disease. Eur J Vasc Endovasc Surg 2021; 62:960-968. [PMID: 34740532 DOI: 10.1016/j.ejvs.2021.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/12/2021] [Accepted: 09/12/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The aim of this study was to examine whether there were independent associations between abdominal aortic diameter, size index, and height index and the risk of major adverse events in patients referred for treatment of various types of aortic and peripheral occlusive and aneurysmal disease (APOAD). METHODS In total, 1 752 participants with a variety of APOADs were prospectively recruited between 2002 and 2020 and had a maximum abdominal aortic diameter, aortic size index (aortic diameter relative to body surface area), and aortic height index (aortic diameter relative to height) measured by ultrasound at recruitment. Participants were followed for a median of 4.6 years (interquartile range 2.0 - 8.0 years) to record outcome events, including major adverse cardiovascular events (MACE), peripheral artery surgery, abdominal aortic aneurysm (AAA) events (rupture or repair), and all cause mortality. The association between aortic size and events was assessed using Cox proportional hazard analysis. The ability of aortic size to improve risk of events classification was assessed using the net reclassification index (NRI). RESULTS After adjusting for other risk factors, larger aortic diameter was associated with an increased risk of MACE (hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.05 - 1.31), requirement for peripheral artery surgery (HR 2.05, 95% CI 1.90 - 2.22), AAA events (HR 3.01, 95% CI 2.77 - 3.26), and all cause mortality (HR 1.20, 95% CI 1.08 - 1.32). Findings were similar for aortic size and aortic height indices. According to the NRI, all three aortic size measures significantly improved classification of risk of peripheral artery surgery and AAA events but not MACE. Aortic size index, but not aortic diameter or aortic height index, significantly improved the classification of all cause mortality risk. CONCLUSION Larger abdominal aortic diameter, size index, and height index are all independently associated with an increased risk of major adverse events in patients with established vascular disease.
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Affiliation(s)
- Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; The Department of Vascular and Endovascular Surgery, The Townsville University Hospital, Townsville, Queensland, Australia; The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia.
| | - Ramesh Velu
- The Department of Vascular and Endovascular Surgery, The Townsville University Hospital, Townsville, Queensland, Australia
| | - Frank Quigley
- The Mater Hospital, Townsville, Queensland, Australia
| | - Jason Jenkins
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Tejas P Singh
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; The Department of Vascular and Endovascular Surgery, The Townsville University Hospital, Townsville, Queensland, Australia
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Zhu F, Arshi B, Ikram MA, De Knegt RJ, Kavousi M. Sex-specific normal values and determinants of infrarenal abdominal aortic diameter among non-aneurysmal elderly population. Sci Rep 2021; 11:17762. [PMID: 34493798 PMCID: PMC8423780 DOI: 10.1038/s41598-021-97209-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/28/2021] [Indexed: 01/16/2023] Open
Abstract
To establish age- and sex-specific distribution of the infrarenal abdominal aortic diameters (IAD) among non-aneurysmal elderly population and to investigate the associations between traditional cardiovascular risk factors and IAD in men and women. We included 4032 participants (mean age 67.2 years; 60.4% women) from the population-based Rotterdam Study, free of cardiovascular disease, who underwent IAD ultrasound assessment between 2009-2014. Linear regression analysis was used to identify determinants of IAD. The medians (inter-quartile range) of absolute IAD and body surface area (BSA)-adjusted IAD were 17.0 (15.0-18.0) mm and 9.3 (8.5-10.2) mm for women and 19.0 (18.0-21.0) mm and 9.4 (8.6-10.3) mm for men, respectively. There was a non-linear relationship between age and IAD. IAD increased steeply with advancing age and up to 70 years. After around 75 years of age, the diameter values reached a plateau. Waist circumference and diastolic blood pressure were associated with larger diameters in both sexes. Body mass index [Effect estimate (95% CI): 0.04 (0.00 to 0.08)], systolic blood pressure [- 0.01(- 0.02 to 0.00)], current smoking [0.35 (0.06 to 0.65)], total cholesterol levels [- 0.21 (- 0.31 to - 0.11)], and lipid-lowering medication [- 0.43 (- 0.67 to - 0.19)] were significantly associated with IAD in women. Sex differences in IAD values diminished after taking BSA into account. The increase in diameters was attenuated after 70 years. Differences were observed in the associations of several cardiovascular risk factors with IAD among men and women.
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Affiliation(s)
- Fang Zhu
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Banafsheh Arshi
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Robert J De Knegt
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
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8
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Systematic review of genome-wide association studies of abdominal aortic aneurysm. Atherosclerosis 2021; 327:39-48. [PMID: 34038762 DOI: 10.1016/j.atherosclerosis.2021.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/27/2021] [Accepted: 05/04/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS Abdominal aortic aneurysm (AAA) is an important cause of death worldwide and has an estimated heritability between 70 and 77%. Genome-wide association studies (GWAS) are an established way to discover genetic risk variants. The aim of this study was to systematically review the findings and quality of previous AAA GWAS. METHODS The Medline, PubMed, Web of Science and relevant genetic databases were searched to identify previous AAA GWAS. A framework was developed to grade the methodological quality of the GWAS. Data from included studies were extracted to assess methods and findings. RESULTS Eight case-control studies were included. Thirty-three of the 38 total single nucleotide polymorphisms (SNPs) previously reported were associated with AAA diagnosis at genome-wide significance (p < 5.0 × 10-8). The CDKN2B antisense RNA-1 gene had the most significant association with AAA diagnosis (p = 6.94 × 10-29 and p = 1.54 × 10-33 for rs4007642 and rs10757274 respectively). Age, sex and smoking history were not reported for the complete cohort in any of the included studies, although five of the eight studies adjusted or matched for at least two confounding variables. All included studies had important design limitations including lack of sample size estimation, inconsistent case and control ascertainment and limited phenotyping of the AAAs. AAA growth was assessed in one GWAS, however, no significant associations with the reported SNPs were found. CONCLUSIONS This systematic review identified 33 SNPs associated with AAA diagnosis at genome-wide significance previously validated in multiple cohorts. The association between SNPs and AAA growth was not adequately examined. Previous GWAS have a number of design limitations.
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Sidloff DA, Saratzis A, Thompson J, Katsogridakis E, Bown MJ. Editor's Choice - Infra-Renal Aortic Diameter and Cardiovascular Risk: Making Better Use of Abdominal Aortic Aneurysm Screening Outcomes. Eur J Vasc Endovasc Surg 2021; 62:38-45. [PMID: 33985908 DOI: 10.1016/j.ejvs.2021.03.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 03/09/2021] [Accepted: 03/13/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Aortic diameter (AD), used traditionally for abdominal aortic aneurysm (AAA) screening may have a role in assessing cardiovascular risk. Unfortunately, AD estimates for those without AAA are underutilised, whilst cardiovascular risk is sub-optimally managed in those with AAA. Our objective was to examine the association between AD measurements and future cardiovascular risk. METHODS Retrospective analysis of three databases of male participants screened for aortic aneurysm disease. Imaging and clinical data were obtained from three independent sources: 1) the Multi-centre Aneurysm Screening Study (MASS) trial (n = 26 882 men); 2) the 2013/14 cohort of the English NHS AAA Screening Programme (NAAASP) (n = 237 441 men) linked with NHS hospital admission and death registry data; and 3) the Framingham Heart Study (FHS) offspring cohort (n = 649). Associations between maximal aortic diameter, as measured on ultrasound or computed tomography, and cardiovascular outcomes were examined. RESULTS Cardiovascular mortality in the MASS trial, was higher in men with AAA at 13 years of follow up, compared to those without (Hazard Ratio [HR] 2.22, 95% CI 1.97-2.50, p < .001). Contemporary risk of major adverse cardiovascular events in the NAAASP was highest in those with an AAA (HR 2.91, 95% CI 2.00-4.25), whilst, extremes of aortic diameter were associated with increased risk for cardiovascular events. Aortic diameter was an independent risk factor for cardiovascular events in the FHS dataset. CONCLUSION Irrespective of the diagnosis of AAA, men attending for AAA screening who are found to have an abnormal aortic diameter are at high risk of future cardiovascular events. This currently unutilised data from AAA screening programmes has the potential to improve preventative management of cardiovascular risk.
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Affiliation(s)
- David A Sidloff
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Athanasios Saratzis
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - John Thompson
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Emmanuel Katsogridakis
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom.
| | - Matt J Bown
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
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10
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Jones GT, Drinkwater B, Blake-Barlow A, Hill GB, Williams MJA, Krysa J, van Rij AM, Coffey S. Both Small and Large Infrarenal Aortic Size is Associated with an Increased Prevalence of Ischaemic Heart Disease. Eur J Vasc Endovasc Surg 2020; 60:594-601. [PMID: 32753305 DOI: 10.1016/j.ejvs.2020.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/03/2020] [Accepted: 06/16/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Past studies have suggested a potential "J shaped" relationship between infrarenal aortic diameter and both cardiovascular disease (CVD) prevalence and all cause mortality. However, screening programmes have focused primarily on large (aneurysmal) aortas. In addition, aortic diameter is rarely adjusted for body size, which is particularly important for women. This study aimed to investigate specifically the relationship between body size adjusted infrarenal aortic diameter and baseline prevalence of CVD. METHODS A retrospective analysis was performed on a total of 4882 elderly (>50 years) participants (mean age 69.4 ± 8.9 years) for whom duplex ultrasound to assess infrarenal abdominal aortic diameters had been performed. History of CVDs, including ischaemic heart disease (IHD), and associated risk factors were collected at the time of assessment. A derivation cohort of 1668 participants was used to select cut offs at the lower and upper 12.5% tails of the aortic size distributions (aortic size index of <0.84 and >1.2, respectively), which was then tested in a separate cohort. RESULTS A significantly elevated prevalence of CVD, and specifically IHD, was observed in participants with both small and large aortas. These associations remained significant following adjustment for age, sex, diabetes, hypertension, dyslipidaemia, obesity (body mass index), and smoking. CONCLUSION The largest and smallest infrarenal aortic sizes were both associated with prevalence of IHD. In addition to identifying those with aneurysmal disease, it is hypothesised that screening programmes examining infrarenal aortic size may also have the potential to improve global CVD risk prediction by identifying those with small aortas.
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Affiliation(s)
- Gregory T Jones
- Department of Surgical Sciences, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand.
| | - Ben Drinkwater
- Department of Surgical Sciences, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand
| | - Ashton Blake-Barlow
- Department of Medicine, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand
| | - Geraldine B Hill
- Department of Surgical Sciences, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand
| | - Michael J A Williams
- Department of Medicine, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand
| | - Jolanta Krysa
- Department of Surgical Sciences, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand
| | - Andre M van Rij
- Department of Surgical Sciences, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand
| | - Sean Coffey
- Department of Medicine, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand
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11
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Kyriakou F, Dempster W, Nash D. Analysing The Cross-Section of The Abdominal Aortic Aneurysm Neck and Its Effects on Stent Deployment. Sci Rep 2020; 10:4673. [PMID: 32170088 PMCID: PMC7070033 DOI: 10.1038/s41598-020-61578-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/28/2020] [Indexed: 11/08/2022] Open
Abstract
Stent graft devices for the treatment of abdominal aortic aneurysms (AAAs) are being increasingly used worldwide. Yet, during modelling and optimization of these devices, as well as in clinical practice, vascular sections are idealized, possibly compromising the effectiveness of the intervention. In this study, we challenge the commonly used approximation of the circular cross-section of the aorta and identify the implications of this approximation to the mechanical assessment of stent grafts. Using computed tomography angiography (CTA) data from 258 AAA patients, the lumen of the aneurysmal neck was analysed. The cross-section of the aortic neck was found to be an independent variable, uncorrelated to other geometrical aspects of the region, and its shape was non-circular reaching elliptical ratios as low as 0.77. These results were used to design a finite element analysis (FEA) study for the assessment of a ring stent bundle deployed under a variety of aortic cross-sections. Results showed that the most common clinical approximations of the vascular cross-section can be a source of significant error when calculating the maximum stent strains (underestimated by up to 69%) and radial forces (overestimated by up to 13%). Nevertheless, a less frequently used average approximation was shown to yield satisfactory results (5% and 2% of divergence respectively).
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Affiliation(s)
- Faidon Kyriakou
- Department of Mechanical and Aerospace Engineering, University of Strathclyde, 75 Montrose Street, Glasgow, G1 1XJ, UK.
| | - William Dempster
- Department of Mechanical and Aerospace Engineering, University of Strathclyde, 75 Montrose Street, Glasgow, G1 1XJ, UK
| | - David Nash
- Department of Mechanical and Aerospace Engineering, University of Strathclyde, 75 Montrose Street, Glasgow, G1 1XJ, UK
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12
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International opinion on priorities in research for small abdominal aortic aneurysms and the potential path for research to impact clinical management. Int J Cardiol 2018; 245:253-255. [PMID: 28874296 DOI: 10.1016/j.ijcard.2017.06.058] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/29/2017] [Accepted: 06/14/2017] [Indexed: 01/16/2023]
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13
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Hamel C, Ghannad M, McInnes MD, Marshall J, Earnshaw J, Ward R, Skidmore B, Garritty C. Potential benefits and harms of offering ultrasound surveillance to men aged 65 years and older with a subaneurysmal (2.5-2.9 cm) infrarenal aorta. J Vasc Surg 2018; 67:1298-1307. [DOI: 10.1016/j.jvs.2017.11.074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/07/2017] [Indexed: 01/09/2023]
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14
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Qazi S, Massaro JM, Chuang ML, D'Agostino RB, Hoffmann U, O'Donnell CJ. Increased Aortic Diameters on Multidetector Computed Tomographic Scan Are Independent Predictors of Incident Adverse Cardiovascular Events: The Framingham Heart Study. Circ Cardiovasc Imaging 2017; 10:e006776. [PMID: 29222122 PMCID: PMC5728667 DOI: 10.1161/circimaging.117.006776] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 11/01/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Adverse aortic remodeling, such as dilation, is associated with multiple cardiovascular disease (CVD) risk factors. We sought to determine whether measures of enlarged aortic diameters improve prediction of incident adverse CVD events above standard CVD risk factors in a community-dwelling cohort. METHODS AND RESULTS Participants from the Framingham Offspring and Third Generation Cohorts (n=3318; aged 48.9±10.3 years), who underwent noncontrast thoracic and abdominal multidetector computed tomography during 2002 to 2005, had complete risk factor profiles, and were free of clinical CVD, were included in this study. Diameters were measured at 4 anatomically defined locations: the ascending thoracic aorta, descending thoracic aorta, the infrarenal abdominal aorta, and lower abdominal aorta. Adverse events comprised CVD death, myocardial infarction, coronary insufficiency, index admission for heart failure, and stroke. Each aortic segment was dichotomized as enlarged (diameter ≥upper 90th percentile for age, sex, and body surface area) or not enlarged; the hazard of an adverse event for an enlarged segment was determined using multivariable-adjusted Cox proportional hazards models. Over a mean 8.8±2.0 years of follow-up, there were 177 incident adverse CVD events. In models adjusted for traditional CVD risk factors, enlarged infrarenal abdominal aorta (hazard ratio=1.57; 95% confidence interval=1.06 to 2.32) and lower abdominal aorta (hazard ratio=1.53; 95% confidence interval=1.00 to 2.34) were associated with an increased hazard of CVD events. Enlarged ascending thoracic aorta and descending thoracic aorta were not significantly associated with CVD events. CONCLUSIONS Among community-dwelling adults initially free of clinical CVD, enlarged infrarenal abdominal aorta and lower abdominal aorta, on noncontrast multidetector computed tomography scans, are independent predictors of incident adverse CVD events above traditional risk factors alone.
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Affiliation(s)
- Saadia Qazi
- From the National Heart, Lung and Blood Institute's Framingham Heart Study, MA (S.Q., J.M.M., M.L.C., R.B.D., U.H., C.J.O.); Department of Biostatistics, Boston University School of Public Health, MA (J.M.M., R.B.D.); Cardiovascular Imaging Core Laboratory, Beth Israel Deaconess Medical Center, Boston, MA (M.L.C.); Cardiac MR PET CT Program and Department of Radiology, Massachusetts General Hospital, Boston (U.H.); Cardiology Section, Boston Veteran's Administration Healthcare, MA (S.Q., C.J.O.); Division of Aging, Brigham and Women's Hospital, Boston, MA (S.Q.); and Harvard Medical School, Boston, MA (S.Q., U.H., C.J.O.)
| | - Joseph M Massaro
- From the National Heart, Lung and Blood Institute's Framingham Heart Study, MA (S.Q., J.M.M., M.L.C., R.B.D., U.H., C.J.O.); Department of Biostatistics, Boston University School of Public Health, MA (J.M.M., R.B.D.); Cardiovascular Imaging Core Laboratory, Beth Israel Deaconess Medical Center, Boston, MA (M.L.C.); Cardiac MR PET CT Program and Department of Radiology, Massachusetts General Hospital, Boston (U.H.); Cardiology Section, Boston Veteran's Administration Healthcare, MA (S.Q., C.J.O.); Division of Aging, Brigham and Women's Hospital, Boston, MA (S.Q.); and Harvard Medical School, Boston, MA (S.Q., U.H., C.J.O.)
| | - Michael L Chuang
- From the National Heart, Lung and Blood Institute's Framingham Heart Study, MA (S.Q., J.M.M., M.L.C., R.B.D., U.H., C.J.O.); Department of Biostatistics, Boston University School of Public Health, MA (J.M.M., R.B.D.); Cardiovascular Imaging Core Laboratory, Beth Israel Deaconess Medical Center, Boston, MA (M.L.C.); Cardiac MR PET CT Program and Department of Radiology, Massachusetts General Hospital, Boston (U.H.); Cardiology Section, Boston Veteran's Administration Healthcare, MA (S.Q., C.J.O.); Division of Aging, Brigham and Women's Hospital, Boston, MA (S.Q.); and Harvard Medical School, Boston, MA (S.Q., U.H., C.J.O.)
| | - Ralph B D'Agostino
- From the National Heart, Lung and Blood Institute's Framingham Heart Study, MA (S.Q., J.M.M., M.L.C., R.B.D., U.H., C.J.O.); Department of Biostatistics, Boston University School of Public Health, MA (J.M.M., R.B.D.); Cardiovascular Imaging Core Laboratory, Beth Israel Deaconess Medical Center, Boston, MA (M.L.C.); Cardiac MR PET CT Program and Department of Radiology, Massachusetts General Hospital, Boston (U.H.); Cardiology Section, Boston Veteran's Administration Healthcare, MA (S.Q., C.J.O.); Division of Aging, Brigham and Women's Hospital, Boston, MA (S.Q.); and Harvard Medical School, Boston, MA (S.Q., U.H., C.J.O.)
| | - Udo Hoffmann
- From the National Heart, Lung and Blood Institute's Framingham Heart Study, MA (S.Q., J.M.M., M.L.C., R.B.D., U.H., C.J.O.); Department of Biostatistics, Boston University School of Public Health, MA (J.M.M., R.B.D.); Cardiovascular Imaging Core Laboratory, Beth Israel Deaconess Medical Center, Boston, MA (M.L.C.); Cardiac MR PET CT Program and Department of Radiology, Massachusetts General Hospital, Boston (U.H.); Cardiology Section, Boston Veteran's Administration Healthcare, MA (S.Q., C.J.O.); Division of Aging, Brigham and Women's Hospital, Boston, MA (S.Q.); and Harvard Medical School, Boston, MA (S.Q., U.H., C.J.O.)
| | - Christopher J O'Donnell
- From the National Heart, Lung and Blood Institute's Framingham Heart Study, MA (S.Q., J.M.M., M.L.C., R.B.D., U.H., C.J.O.); Department of Biostatistics, Boston University School of Public Health, MA (J.M.M., R.B.D.); Cardiovascular Imaging Core Laboratory, Beth Israel Deaconess Medical Center, Boston, MA (M.L.C.); Cardiac MR PET CT Program and Department of Radiology, Massachusetts General Hospital, Boston (U.H.); Cardiology Section, Boston Veteran's Administration Healthcare, MA (S.Q., C.J.O.); Division of Aging, Brigham and Women's Hospital, Boston, MA (S.Q.); and Harvard Medical School, Boston, MA (S.Q., U.H., C.J.O.).
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15
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Small infrarenal aortic diameter associated with lower-extremity peripheral artery disease in Chinese hypertensive adults. Sci Rep 2017; 7:14547. [PMID: 29109408 PMCID: PMC5674057 DOI: 10.1038/s41598-017-12587-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 09/07/2017] [Indexed: 11/18/2022] Open
Abstract
Several studies suggest that infrarenal aortic diameter is associated with lower-extremity peripheral artery disease (LE-PAD). However, data regarding the associations between infrarenal aortic diameter and LE-PAD are limited, especially in large sample populations and Asian or Chinese populations. Our analysis included 17279 Chinese hypertensive adults comprising 6590 men and 10689 women with a mean age of 64.74 ± 7.41 years. Participants were selected from 22693 candidates from two large population-based cohort-studies. The primary noninvasive test for diagnosis of LE-PAD is the ankle–brachial index (ABI) at rest and typically an ABI ≤ 0.90 is used to define LE-PAD. The prevalence of LE-PAD was found to significantly decrease as the aortic diameter increased according to the tertile of the aortic diameter. LE-PAD was significantly more prevalent in the lowest tertile (OR = 1.58, 95% CI = 1.29–1.94, p < 0.001) and similarly prevalent in the highest tertile (OR = 0.92, 95% CI = 0.73–1.16, p = 0.49) when compared with the median tertile. No significant interactions between the aortic diameter and any of the stratified variables were found (all p > 0.05). In conclusion, Small aortic diameter (as opposed to large aortic diameter) is significantly associated with LE-PAD in Chinese hypertensive adults.
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16
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Spencer SM, Trower AJ, Jia X, Scott DJA, Greenwood DC. Meta-analysis of the association between alcohol consumption and abdominal aortic aneurysm. Br J Surg 2017; 104:1756-1764. [DOI: 10.1002/bjs.10674] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/19/2017] [Accepted: 07/11/2017] [Indexed: 12/25/2022]
Abstract
Abstract
Background
Alcohol is a possible risk factor for abdominal aortic aneurysm (AAA), but evidence from individual studies is weak and inconsistent. Existing narrative reviews suggest the possibility of non-linear associations. The aim here was to quantify any association using a systematic literature review, followed by dose–response meta-analysis of prospective studies.
Methods
MEDLINE, Embase and Web of Science were searched systematically to January 2017 for relevant prospective studies of alcohol consumption and AAA risk. Summary estimates of highest versus lowest levels of consumption, and linear and non-linear dose–response curves were quantified using random-effects models.
Results
Eleven relevant cohorts were identified describing results from 3580 individuals with among 473 092 participants. Data were extracted from ten cohorts for meta-analyses of high versus low levels of alcohol consumption (risk ratio for AAA 0·93, 95 per cent c.i. 0·78 to 1·11; P = 0·4, I2 = 47 per cent). The linear dose–response risk ratio for AAA, derived from 11 cohorts, was 1·00 (0·97 to 1·04) per 8 g alcohol per day (P = 0·9, I2 = 73 per cent). Non-linear dose–response results showed a tick-shaped curve with lower risk up to 2 units/day, but increasing risk beyond that (P = 0·05). The increase in risk beyond 2 units/day was stronger in men than in women.
Conclusion
Although the linear dose–response analysis revealed little evidence of an association between alcohol consumption and AAA risk, a tick-shaped trend in the association was observed. This non-linear dose–response analysis revealed reduced risks for alcohol consumption below 2 units/day, masking increased risks for 2 or more units/day.
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Affiliation(s)
- S M Spencer
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
- Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, Leeds, UK
| | - A J Trower
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
- Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, Leeds, UK
| | - X Jia
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
- Department of Vascular Surgery, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D J A Scott
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
- Department of Vascular Surgery, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D C Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
- Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, Leeds, UK
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17
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Khashram M, Hider PN, Williman JA, Jones GT, Roake JA. Does the diameter of abdominal aortic aneurysm influence late survival following abdominal aortic aneurysm repair? A systematic review and meta-analysis. Vascular 2016; 24:658-667. [DOI: 10.1177/1708538116650580] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Studies reporting the influence of preoperative abdominal aortic aneurysm diameter on late survival following abdominal aortic aneurysm repair have not been consistent. Aim: To report the influence of abdominal aortic aneurysm diameter on overall long-term survival following abdominal aortic aneurysm repair. Methods Embase, Medline and the Cochrane electronic databases were searched to identify articles reporting the influence of abdominal aortic aneurysm diameter on late survival following open aneurysm repair and endovascular aneurysm repair published up to April 2015. Data were extracted from multivariate analysis; estimated risks were expressed as hazard ratio. Results A total of 2167 titles/abstracts were retrieved, of which 76 studies were fully assessed; 19 studies reporting on 22,104 patients were included. Preoperative larger abdominal aortic aneurysm size was associated with a worse survival compared to smaller aneurysms with a pooled hazard ratio of 1.14 (95% CI: 1.09–1.18), per 1 cm increase in abdominal aortic aneurysm diameter. Subgroup analysis of the different types of repair was performed and the hazard ratio (95% CI), for open aneurysm repair and endovascular aneurysm repair were 1.08 (1.03–1.12) and 1.20 (1.15–1.25), respectively, per 1 cm increase. There was a significant difference between the groups p < 0.02. Conclusions This meta-analysis suggests that preoperative large abdominal aortic aneurysm independently influences overall late survival following abdominal aortic aneurysm repair, and this association was greater in abdominal aortic aneurysm repaired with endovascular aneurysm repair.
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Affiliation(s)
- Manar Khashram
- Department of Surgery, University of Otago, Christchurch, New Zealand
- Department of Vascular Endovascular & Transplant Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Phil N Hider
- Department of Population Health, University of Otago, Christchurch, New Zealand
| | - Jonathan A Williman
- Department of Population Health, University of Otago, Christchurch, New Zealand
| | - Gregory T Jones
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Christchurch, New Zealand
| | - Justin A Roake
- Department of Vascular Endovascular & Transplant Surgery, Christchurch Hospital, Christchurch, New Zealand
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18
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Bath MF, Gokani VJ, Sidloff DA, Jones LR, Choke E, Sayers RD, Bown MJ. Systematic review of cardiovascular disease and cardiovascular death in patients with a small abdominal aortic aneurysm. Br J Surg 2015; 102:866-72. [DOI: 10.1002/bjs.9837] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 01/05/2015] [Accepted: 03/26/2015] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Screening for abdominal aortic aneurysm (AAA) has reduced the rate of AAA rupture. However, cardiovascular disease is still a major cause of death in men with an AAA. The aim of this study was to assess cardiovascular risk in patients with a small AAA.
Methods
Standard PRISMA guidelines were followed. Analysis was performed of studies reporting cardiovascular outcomes in patients with a small AAA (30–54 mm). Weighted metaregression was performed for cardiovascular death in patients with a small AAA, and the prevalence of cardiovascular disease was reviewed.
Results
Twenty-one articles were identified describing patients with an AAA, and the prevalence of, and death from, cardiovascular disease. Ten of these reported cardiovascular death rates in patients with a small AAA. Some 2323 patients with a small AAA were identified; 335 cardiovascular deaths occurred, of which 37 were due to AAA rupture. Metaregression demonstrated that the risk of cardiovascular death was 3·0 (95 per cent c.i. 1·7 to 4·3) per cent per year in patients with a small AAA (R2 = 0·902, P < 0·001). The prevalence of ischaemic heart disease (44·9 per cent), myocardial infarction (26·8 per cent), heart failure (4·4 per cent) and stroke (14·0 per cent) was also high in these patients.
Conclusion
The risk of cardiovascular death in patients with a small AAA is high and increases by approximately 3 per cent each year after diagnosis. Patients with a small AAA have a high prevalence of cardiovascular disease. Patients a small AAA should be considered for lifestyle modifications and secondary cardiovascular protection.
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Affiliation(s)
- M F Bath
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - V J Gokani
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - D A Sidloff
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - L R Jones
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - E Choke
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - R D Sayers
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - M J Bown
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, UK
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19
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Ciccone MM, Bilianou E, Balbarini A, Gesualdo M, Ghiadoni L, Metra M, Palmiero P, Pedrinelli R, Salvetti M, Scicchitano P, Zito A, Novo S, Mattioli AV. Task force on: 'Early markers of atherosclerosis: influence of age and sex'. J Cardiovasc Med (Hagerstown) 2014; 14:757-66. [PMID: 24335886 DOI: 10.2459/jcm.0b013e328362078d] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Atherosclerosis and its complications are the most important causes of death all over the world, especially in Western countries. Diet habits, modern stress life, smoking, sedentary way of life and an involvement of genetic pattern of individuals lead to a sure degeneration of quality of life increasing the risk of atherosclerosis development. For this reason, the main purpose of actual medicine is to identify all the markers that could allow the physicians to evaluate the first moments of the development of this dangerous pathological process. The aim is to reduce the speed of its evolution, trying to delay indefinitely the risk coming from the morphological alterations of the vessels. 'Endothelium function' could allow physicians to detect the first moment of the natural history of atherosclerosis process. Its impairment is the first step in the degeneration of vascular structures. Many methods [flow-mediated vasodilatation (FMD); antero-posterior abdominal aorta diameter (APAO); intima-media thickness of the common carotid artery (CCA-IMT); arterial stiffness; and so on] try to evaluate its function, but many limitations come from general population characteristics. A standardization of the methods should take into account individuals' peculiarities. Two elements, not modifiable, should be taken into account for vascular evaluation: age and sex. The aim of this review is to outline the linkage among age, sex and instrumental evaluation of patients considered for a noninvasive assessment of their cardiovascular risk profile.
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Affiliation(s)
- Marco Matteo Ciccone
- aCardiovascular Diseases Section, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy bCardiology Department, Tzanio State Hospital, Piraeus, Greece cCardio-Thoracic and Vascular Department dInternal Medicine Department, University of Pisa, Pisa eCardiovascular Diseases Section, University of Brescia, Brescia fASL BR/1, Brindisi gDepartment of Medical and Surgical Sciences, University of Brescia, Brescia hCardiovascular Diseases Section, University of Palermo, Palermo iCardiovascular Diseases Section, University of Modena and Reggio Emilia, Emilia-Romagna, Italy
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20
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Kontopodis N, Metaxa E, Papaharilaou Y, Georgakarakos E, Tsetis D, Ioannou CV. Value of volume measurements in evaluating abdominal aortic aneurysms growth rate and need for surgical treatment. Eur J Radiol 2014; 83:1051-1056. [PMID: 24768189 DOI: 10.1016/j.ejrad.2014.03.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Revised: 03/14/2014] [Accepted: 03/19/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE To examine whether indices other than the traditionally used abdominal aortic aneurysm (AAA) maximum diameter, such as AAA volume, intraluminal thrombus (ILT) thickness and ILT volume, may be superior to evaluate aneurismal enlargement. MATERIALS AND METHODS Thirty-four small AAAs (initially presenting a maximum diameter <5.5cm which is the threshold for surgical repair) with an initial and a follow-up CT were examined. Median increase and percentile annual change of these variables was calculated. Correlation between growth rates as determined by the new indices under evaluation and those of maximum diameter were assessed. AAAs were divided according to outcome (surveillance vs. elective repair after follow-up which is based on the maximum diameter criterion) and according to growth rate (high vs. low) based on four indices. Contingency between groups of high/low growth rate regarding each of the four indices on one hand and those regarding need for surgical repair on the other was assessed. RESULTS A strong correlation between growth rates of maximum diameter and those of AAA and ILT volumes could be established. Evaluation of contingency between groups of outcome and those of growth rate revealed significant associations only for AAA and ILT volumes. Subsequently AAAs with a rapid volumetric increase over time had a likelihood ratio of 10 to be operated compared to those with a slower enlargement. Regarding increase of maximum diameter, likelihood ratio between AAAs with rapid and those with slow expansion was only 3. CONCLUSION Growth rate of aneurysms regarding 3Dimensional indices of AAA and ILT volumes is significantly associated with the need for surgical intervention while the same does not hold for growth rates determined by 2Dimensional indices of maximum diameter and ILT thickness.
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Affiliation(s)
- Nikolaos Kontopodis
- Department of Vascular Surgery, University of Crete Medical School, Heraklion, Greece.
| | - Eleni Metaxa
- Institute of Applied and Computational Mathematics, Foundation for Research and Technology-Hellas, Heraklion, Crete, Greece.
| | - Yannis Papaharilaou
- Institute of Applied and Computational Mathematics, Foundation for Research and Technology-Hellas, Heraklion, Crete, Greece.
| | - Efstratios Georgakarakos
- Vascular Surgery Department, "Demokritus" University of Thrace Medical School, Alexandroupolis, Greece.
| | - Dimitris Tsetis
- Interventional Radiology Unit, Department of Radiology, University of Crete Medical School, Heraklion, Crete, Greece.
| | - Christos V Ioannou
- Department of Vascular Surgery, University of Crete Medical School, Heraklion, Greece.
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21
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Assar AN. Pharmacological therapy for patients with abdominal aortic aneurysm. Expert Rev Cardiovasc Ther 2014; 7:999-1009. [DOI: 10.1586/erc.09.56] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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22
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Takahashi T, Takeuchi K, Ito T, Hayashi S, Qu N, Itoh M. Positional relationships of abdominal aorta landmarks for angiography: observations from the intravascular space. Surg Radiol Anat 2013; 36:681-8. [PMID: 24370577 DOI: 10.1007/s00276-013-1249-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 12/12/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE To clarify the positional relationships of abdominal aorta (Ao) landmarks by way of observations from the intravascular space to facilitate angiography. METHODS A total of 95 donated Japanese cadavers were observed. We excluded 32 cadavers with anatomical variation at the celiac trunk (CT) or superior mesenteric artery (SMA), with flexure exceeding 5° in the aorta located cranially to the renal artery (RA), and with flexure exceeding 60° in the aorta located caudal to the RA. The maximum longitudinal diameter of the left (Lt.) RA was measured and the Ao was incised by frontal section to acquire photographs of the intravascular space. The inner diameter of the Ao at the Lt. RA level was investigated. The distances between the inferior borders of the CT, SMA, and Lt. RA were also used as the hypotenuse of a right-angled triangle. Lines parallel to the longitudinal diameter of the Ao and those parallel to the transverse diameter of the right-angled triangle were measured by a computer, and expressed as relative distance indexes using the transverse diameter of the aorta at the Lt. RA level as a reference point. The angle between the transverse axis of the Ao and the line connecting the CT to the SMA was also investigated. RESULTS The mean diameter of the aorta was 20.6 ± 2.0 mm. The indexes between each blood vessel (longitudinal/transverse) were as follows: Lt. RA to CT 1.69/0.41, Lt. RA to SMA 0.86/0.51, and CT to SMA 0.82/0.13. The mean angle between the transverse axis of the Ao and CT to SMA was 81.9° ± 9.5°. CONCLUSION These indexes should contribute to improving skills for workers new to angiography, and may reduce patient risk.
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Affiliation(s)
- Tetsuya Takahashi
- Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo, 160-8402, Japan,
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Golledge J, Clancy P, Yeap BB, Hankey GJ, Norman PE. Increased serum angiopoietin-2 is associated with abdominal aortic aneurysm prevalence and cardiovascular mortality in older men. Int J Cardiol 2013; 167:1159-63. [DOI: 10.1016/j.ijcard.2012.03.120] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 02/08/2012] [Accepted: 03/10/2012] [Indexed: 01/28/2023]
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24
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Wong YY, Golledge J, Flicker L, McCaul KA, Hankey GJ, van Bockxmeer FM, Yeap BB, Norman PE. Plasma total homocysteine is associated with abdominal aortic aneurysm and aortic diameter in older men. J Vasc Surg 2013; 58:364-70. [DOI: 10.1016/j.jvs.2013.01.046] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 01/23/2013] [Accepted: 01/24/2013] [Indexed: 12/30/2022]
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Hardman D, Doyle BJ, Semple SIK, Richards JMJ, Newby DE, Easson WJ, Hoskins PR. On the prediction of monocyte deposition in abdominal aortic aneurysms using computational fluid dynamics. Proc Inst Mech Eng H 2013; 227:1114-24. [DOI: 10.1177/0954411913494319] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In abdominal aortic aneurysm disease, the aortic wall is exposed to intense biological activity involving inflammation and matrix metalloproteinase–mediated degradation of the extracellular matrix. These processes are orchestrated by monocytes and rather than affecting the aorta uniformly, damage and weaken focal areas of the wall leaving it vulnerable to rupture. This study attempts to model numerically the deposition of monocytes using large eddy simulation, discrete phase modelling and near-wall particle residence time. The model was first applied to idealised aneurysms and then to three patient-specific lumen geometries using three-component inlet velocities derived from phase-contrast magnetic resonance imaging. The use of a novel, variable wall shear stress-limiter based on previous experimental data significantly improved the results. Simulations identified a critical diameter (1.8 times the inlet diameter) beyond which significant monocyte deposition is expected to occur. Monocyte adhesion occurred proximally in smaller abdominal aortic aneurysms and distally as the sac expands. The near-wall particle residence time observed in each of the patient-specific models was markedly different. Discrete hotspots of monocyte residence time were detected, suggesting that the monocyte infiltration responsible for the breakdown of the abdominal aortic aneurysm wall occurs heterogeneously. Peak monocyte residence time was found to increase with aneurysm sac size. Further work addressing certain limitations is needed in a larger cohort to determine clinical significance.
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Affiliation(s)
- David Hardman
- Centre for Cardiovascular Science, Queens Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Barry J Doyle
- Centre for Cardiovascular Science, Queens Medical Research Institute, The University of Edinburgh, Edinburgh, UK
- Intelligent Systems for Medicine Laboratory, School of Mechanical and Chemical Engineering, The University of Western Australia, Crawley, WA, Australia
| | - Scott IK Semple
- Centre for Cardiovascular Science, Queens Medical Research Institute, The University of Edinburgh, Edinburgh, UK
- Clinical Research Imaging Centre, The University of Edinburgh, Edinburgh, UK
| | - Jennifer MJ Richards
- Centre for Cardiovascular Science, Queens Medical Research Institute, The University of Edinburgh, Edinburgh, UK
- Clinical Research Imaging Centre, The University of Edinburgh, Edinburgh, UK
- Centre of Clinical and Surgical Sciences (Surgery), The University of Edinburgh, Edinburgh, UK
| | - David E Newby
- Centre for Cardiovascular Science, Queens Medical Research Institute, The University of Edinburgh, Edinburgh, UK
- Clinical Research Imaging Centre, The University of Edinburgh, Edinburgh, UK
| | - William J Easson
- Institute for Materials and Processes, School of Engineering and Electronics, The University of Edinburgh, Edinburgh, UK
| | - Peter R Hoskins
- Centre for Cardiovascular Science, Queens Medical Research Institute, The University of Edinburgh, Edinburgh, UK
- Department of Mechanical, Aeronautical and Biomedical Engineering, University of Limerick, Limerick, Ireland
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Kitagawa A, Mastracci TM, von Allmen R, Powell JT. The role of diameter versus volume as the best prognostic measurement of abdominal aortic aneurysms. J Vasc Surg 2013; 58:258-65. [DOI: 10.1016/j.jvs.2013.05.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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27
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Kitagawa A, Mastracci T. Part One: For the Motion. External Diameter for AAA Size. Eur J Vasc Endovasc Surg 2013; 46:1-5. [DOI: 10.1016/j.ejvs.2013.04.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Plasma thrombin-antithrombin complex, prothrombin fragments 1 and 2, and D-dimer levels are elevated after endovascular but not open repair of infrarenal abdominal aortic aneurysm. J Vasc Surg 2013; 57:1512-8. [DOI: 10.1016/j.jvs.2012.12.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 11/30/2012] [Accepted: 12/05/2012] [Indexed: 11/22/2022]
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Wong YYE, Flicker L, Yeap BB, McCaul KA, Hankey GJ, Norman PE. Is hypovitaminosis D associated with abdominal aortic aneurysm, and is there a dose-response relationship? Eur J Vasc Endovasc Surg 2013; 45:657-64. [PMID: 23602862 DOI: 10.1016/j.ejvs.2013.03.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 03/14/2013] [Indexed: 01/20/2023]
Abstract
OBJECTIVE This study aims to investigate the association between plasma 25-hydroxyvitamin D (25(OH)D) concentrations with the presence of abdominal aortic aneurysm (AAA) and aortic diameter. DESIGN An observational study of 4233 community-dwelling men aged 70-88 years, who participated in a randomised controlled trial of screening for AAA. METHODS Infrarenal aortic diameter measured by ultrasound and 25(OH)D by immunoassay. RESULTS A total of 311 men (7.4%) with AAA (defined as aortic diameter ≥ 30 mm) comprised the study. Multivariable models were adjusted for age, smoking, cardiovascular disease, hypertension, diabetes, dyslipidaemia, body mass index and serum creatinine concentration. Amongst men with the lowest 25(OH)D quartile of values compared with the highest quartile, the adjusted odds ratio of having an AAA increased in a graded fashion from 1.23 (95% confidence interval (CI) 0.87-1.73) for AAA ≥ 30 mm to 5.42 (95% CI 1.85-15.88) for AAA ≥ 40 mm. Similarly, there was a dose-response relationship between 25(OH)D concentrations and the size of the AAA: every 10-nmol l(-1) decrease in 25(OH)D levels was associated with 0.49 mm (95% CI 0.11-0.87) increase in mean aortic diameter. CONCLUSIONS Low vitamin D status is associated with the presence of larger AAA in older men, and there is a graded inverse relationship between 25(OH)D concentrations and AAA diameter. Further research is needed to clarify the mechanisms underlying these associations.
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Affiliation(s)
- Y Y E Wong
- Western Australian Centre for Health and Ageing, Centre for Medical Research, Western Australian Institute for Medical Research, Perth, Australia.
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30
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Metabolomic study of plasma of patients with abdominal aortic aneurysm. Anal Bioanal Chem 2012; 403:1651-60. [DOI: 10.1007/s00216-012-5982-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 03/25/2012] [Accepted: 03/26/2012] [Indexed: 10/28/2022]
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Plasma profiling by a protein array approach identifies IGFBP-1 as a novel biomarker of abdominal aortic aneurysm. Atherosclerosis 2012; 221:544-50. [DOI: 10.1016/j.atherosclerosis.2012.01.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 01/04/2012] [Accepted: 01/04/2012] [Indexed: 01/05/2023]
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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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Genomic research to identify novel pathways in the development of abdominal aortic aneurysm. Cardiol Res Pract 2012; 2012:852829. [PMID: 22400124 PMCID: PMC3286885 DOI: 10.1155/2012/852829] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 10/27/2011] [Indexed: 11/18/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is a common disease with a large heritable component. There is a need to improve our understanding of AAA pathogenesis in order to develop novel treatment paradigms. Genomewide association studies have revolutionized research into the genetic variants that underpin the development of many complex diseases including AAA. This article reviews the progress that has been made to date in this regard, including mechanisms by which loci identified by GWAS may contribute to the development of AAA. It also highlights potential post-GWAS analytical strategies to improve our understanding of the disease further.
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Changes in thrombin generation, fibrinolysis, platelet and endothelial cell activity, and inflammation following endovascular abdominal aortic aneurysm repair. J Vasc Surg 2012; 55:41-6. [DOI: 10.1016/j.jvs.2011.07.094] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 07/26/2011] [Accepted: 07/28/2011] [Indexed: 11/18/2022]
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35
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The cardiovascular and prognostic significance of the infrarenal aortic diameter. J Vasc Surg 2011; 54:1817-20. [DOI: 10.1016/j.jvs.2011.07.048] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 06/20/2011] [Accepted: 07/06/2011] [Indexed: 11/21/2022]
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Ohrlander T, Merlo J, Ohlsson H, Sonesson B, Acosta S. Socioeconomic position, comorbidity, and mortality in aortic aneurysms: a 13-year prospective cohort study. Ann Vasc Surg 2011; 26:312-21. [PMID: 22079461 DOI: 10.1016/j.avsg.2011.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 01/31/2011] [Accepted: 08/03/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND To evaluate factors associated with incidence and 3-year all-cause mortality in patients with aortic aneurysm (AA). The design is sex and age-stratified (60-79 and 80-90 years) prospective cohort. By using the population register, we constituted a cohort of all men and women born between 1900 and 1930 and living in Scania by 1991, and followed them for 13 years. Identification of AA was based on hospital discharge diagnosis obtained from the Swedish Patient Register or from the information on death certificates from the Cause of Death Register. METHODS We applied stepwise Cox regression and investigated both AA incidence (1991-2003) as well as 3-year survival after the first hospitalization for AA. RESULTS We found an inverse relation between AA incidence and previous hospitalization by diabetes mellitus in women (hazard ratio [HR]: 0.41; 95% confidence interval [CI]: 0.19-0.88) and in men (HR: 0.38; 95% CI: 0.24-0.61) aged 60-79 years. Three-year all-cause mortality after diagnosis of AA was 58.6% in women, 50.2% in men, 72.9% in octogenarians, and 43.7% for nonoctogenarians. Low income, chronic respiratory diseases, cerebrovascular diseases, dementia, systemic connective tissue disorders, renal failure, and malignant neoplasms were independent factors for mortality in 60-79-year-old men with AA. CONCLUSIONS Inferior socioeconomic position is associated with increased 3-year all-cause mortality in 60-79-year-old men with AA.
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Affiliation(s)
- Tomas Ohrlander
- Vascular Center Malmö-Lund, Malmö University Hospital, Malmö, Sweden
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37
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Bui HT, Barbe C, Nazeyrollas P, Metz D, Long A. Cardiovascular Prognosis at 1-Year of Patients With Acute Coronary Syndrome Is Related to Abdominal Aortic Aneurysm Despite Small Size of the Aneurysm. Ann Vasc Surg 2011; 25:913-9. [DOI: 10.1016/j.avsg.2011.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 03/10/2011] [Accepted: 03/10/2011] [Indexed: 11/26/2022]
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Harrison SC, Holmes MV, Agu O, Humphries SE. Genome wide association studies of abdominal aortic aneurysms-biological insights and potential translation applications. Atherosclerosis 2011; 217:47-56. [PMID: 21414622 DOI: 10.1016/j.atherosclerosis.2011.02.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 02/22/2011] [Accepted: 02/22/2011] [Indexed: 12/30/2022]
Abstract
Abdominal aortic aneurysm (AAA) is a complex disease with important environmental risk factors and a heritability of approximately 70%. Genome wide association studies have revolutionised the study of complex disorders and offer the potential for innovative insight into disease pathogenesis and development of individualised therapeutic options. This paper reviews the progress of genome wide association studies in AAA, highlighting novel disease pathways and potential translational applications of genomic discoveries.
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Affiliation(s)
- Seamus C Harrison
- Centre for Cardiovascular Genetics, BHF Laboratories, The Rayne Building, Department of Medicine, University College London (UCL), London WC1E 6JF, UK.
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Parr A, McCann M, Bradshaw B, Shahzad A, Buttner P, Golledge J. Thrombus volume is associated with cardiovascular events and aneurysm growth in patients who have abdominal aortic aneurysms. J Vasc Surg 2011; 53:28-35. [PMID: 20934838 DOI: 10.1016/j.jvs.2010.08.013] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 07/27/2010] [Accepted: 08/04/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with abdominal aortic aneurysms (AAA) are predisposed to cardiovascular events and often experience continual expansion of their aneurysm. Cardiovascular events and expansion rates are positively correlated with aneurysm size. AAA is usually associated with intraluminal thrombus, which has previously been implicated in AAA pathogenesis. This study prospectively assessed the association of infrarenal abdominal aortic thrombus volume with cardiovascular events and AAA growth. METHODS Ninety-eight patients with AAAs underwent computed tomography angiography (CTA). The volume of infrarenal aorta thrombus was measured by a previously validated technique. Patients were monitored prospectively for a median of 3 years (interquartile range [IQR], 2.0-3.6 years), and cardiovascular events (nonfatal stroke, nonfatal myocardial infarction, coronary revascularization, amputation, and cardiovascular death) were recorded. Of the original patients, 39 underwent repeat CTA a median of 1.5 years (IQR, 1.1-3.3 years) after entry to the study. Kaplan-Meier and Cox proportional analysis were used to examine the association of aortic thrombus with cardiovascular events and average weighted AAA growth. RESULTS There were 28 cardiovascular events during follow-up. The incidence of cardiovascular events was 23.4% and 49.2% for patients with small (smaller than the median) and large (median or larger) volumes of aortic thrombus, respectively, at 4 years (P = .040). AAA thrombus volume of median or larger was associated with increased cardiovascular events (relative risk [RR] 2.8, 95% confidence interval [CI], 1.01-5.24) independent of other risk factors, including initial AAA diameter, but was only of borderline significance when patients were censored at the time of AAA repair (RR, 2.35; 95% CI, 0.98-5.63). In the subset of patients with CTA follow-up, the median annual increase in AAA volume was 5.1 cm³ (IQR, 0.8-10.3 cm³). Annual AAA volume increase was positively correlated with initial AAA diameter (r = 0.44, P = .006) and thrombus volume (r = 0.50, P = .001). Median or larger aortic thrombus volume was associated with rapid AAA volume increase (≥ 5 cm/y), independent of initial aortic diameter (RR, 15.0; 95% CI, 1.9-115.7; P = .009). CONCLUSION In this small cohort, infrarenal aortic thrombus volume was associated with the incidence of cardiovascular events and AAA progression. These results need to be confirmed and mechanisms underlying the associations clarified in large further studies.
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Affiliation(s)
- Adam Parr
- Vascular Biology Unit, James Cook University, Townsville, Queensland, Australia
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Lakshmanan R, Hyde Z, Jamrozik K, Hankey GJ, Norman PE. Population-based observational study of claudication in older men: the Health in Men Study. Med J Aust 2010; 192:641-5. [PMID: 20528717 DOI: 10.5694/j.1326-5377.2010.tb03663.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 02/11/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess the prevalence of and risk factors for claudication and its association with subsequent cardiovascular events. DESIGN, SETTING AND PARTICIPANTS Observational cohort study of 12 203 Western Australian men aged 65 years and over, recruited from 1996 to 1999, and followed up from 2001 to 2004. MAIN OUTCOME MEASURES Prevalence of claudication and incidence of peripheral arterial disease (PAD); risk factors for claudication and its association with subsequent cardiovascular events. RESULTS The prevalence of claudication was 5.3% (638 of 11 970 men). At follow-up, after exclusion of 148 men with claudication at baseline and 76 with missing data at follow-up, the crude average annual incidence of new PAD (claudication or procedure for PAD) was 0.85% (95% CI, 0.72%-0.96%). The risk factors for prevalent claudication and incident PAD were similar, with age, smoking, hypertension, diabetes and history of cardiovascular disease dominating. Of the men with claudication at baseline, nearly half (47.5%; 303 of 638) were not taking aspirin. At follow-up, 42.5% (82 of 193) of the men with incident PAD were not taking aspirin. Claudication at baseline was associated with twice the risk of cardiovascular death (hazard ratio, 2.00; 95% CI, 1.52-2.64). There was a J-shaped relationship between aortic diameter, and both prevalent claudication and subsequent cardiovascular events. CONCLUSIONS Among older men, claudication is prevalent and is associated with factors that can still be modified in older age, including smoking, exercise and diet. Relatively few men with claudication or at risk of PAD use aspirin. Claudication is a significant predictor of cardiovascular outcome.
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Affiliation(s)
- Rahul Lakshmanan
- University of Western Australia, Fremantle Hospital, Fremantle, WA, Australia
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Long A, Bui HT, Barbe C, Henni AH, Journet J, Metz D, Nazeyrollas P. Prevalence of Abdominal Aortic Aneurysm and Large Infrarenal Aorta in Patients With Acute Coronary Syndrome and Proven Coronary Stenosis: A Prospective Monocenter Study. Ann Vasc Surg 2010; 24:602-8. [DOI: 10.1016/j.avsg.2009.12.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 09/29/2009] [Accepted: 12/04/2009] [Indexed: 10/19/2022]
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Parr A, Buttner P, Shahzad A, Golledge J. Relation of infra-renal abdominal aortic calcific deposits and cardiovascular events in patients with peripheral artery disease. Am J Cardiol 2010; 105:895-9. [PMID: 20211340 DOI: 10.1016/j.amjcard.2009.10.067] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 10/28/2009] [Accepted: 10/28/2009] [Indexed: 01/28/2023]
Abstract
In patients with peripheral artery disease, aortic calcific deposits are a common finding. The aim of this study was to assess the association of infrarenal abdominal aortic calcific deposits with prospective cardiovascular events in patients with peripheral artery disease. A consecutive series of 213 patients who presented for investigation of abdominal aortic aneurysm or intermittent claudication were assessed using computed tomographic angiography. Infrarenal abdominal aortic calcific deposits were estimated using a previously defined highly reproducible semiautomated program. Patients were followed prospectively for a median of 2.8 years (interquartile range 1.7 to 3.6), and cardiovascular events were recorded. Kaplan-Meier and Cox proportional-hazards analysis were used to examine the association of calcific deposits with cardiovascular events. A total of 45 cardiovascular events occurred during follow-up, including nonfatal myocardial infarction (n = 23), coronary revascularization (n = 6), stroke (n = 3), below-knee amputation (n = 2), and cardiovascular death (n = 11). The incidence of cardiovascular events was 21.7%, 33.0%, and 36.9% for patients with mild (<400 mm(3)), intermediate (400 to 1,700 mm(3)), and severe (>1,700 mm(3)) abdominal aortic calcific deposits, respectively (p = 0.039). Calcific deposit volume >400 mm(3) (relative risk 2.8, 95% confidence interval 1.2 to 6.6) and coronary artery disease (relative risk 2.8, 95% confidence interval 1.4 to 5.6) were independently associated with increased cardiovascular events during follow-up. In conclusion, abdominal aortic calcific deposits are prognostic for cardiovascular events in patients with peripheral artery disease.
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Parr A, Jayaratne C, Buttner P, Golledge J. Comparison of volume and diameter measurement in assessing small abdominal aortic aneurysm expansion examined using computed tomographic angiography. Eur J Radiol 2010; 79:42-7. [PMID: 20061105 DOI: 10.1016/j.ejrad.2009.12.018] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Revised: 12/13/2009] [Accepted: 12/14/2009] [Indexed: 12/23/2022]
Abstract
AIM First we aimed to assess the reproducibility of a computer tomography angiography (CTA) based technique for measuring infra-renal aortic volume and diameter. Second we sought to investigate whether changes in aortic volume and diameter were similar during follow-up. MATERIALS AND METHODS A prospective series of 57 patients, with aortic diameter initially measuring between 25 and 55 mm, were assessed with 2 CTAs a median of 14 months apart. Aortic volume and maximum diameter (both axial and orthogonal) were measured by a semi-automated workstation protocol based on previously defined techniques. Intra- and inter-observer reproducibility were assessed by repeat assessment of the initial CTA images of the first 33 patients included in the study, in order to estimate the 95% limits of agreements. Changes in aortic dimensions between the first and follow-up CTA, were defined for volume and diameter separately as changes greater than their respective 95% limits of agreement. RESULTS Reproducibility of aortic volume and diameter was excellent with an average coefficient of variation <4%. The median (inter-quartile range) increases in total volume, orthogonal and axial diameters were 4.9 cm(3) (0.01-14.18), 1.2mm (0.40-3.50) and 1.4mm (-0.15 to 3.55) respectively. Forty-two percent of patients who had increased aortic volume above the 95% limit of agreement did not display corresponding axial or orthogonal diameter changes. CONCLUSIONS Infra-renal total aortic volume, axial and orthogonal diameter can all be measured reproducibly from CTA. Aortic volume changes are not always reflected by similar changes in diameter and therefore provide complementary information when assessing AAA expansion over time.
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Affiliation(s)
- Adam Parr
- The Vascular Biology Unit, James Cook University, Townsville, Queensland 4811, Australia
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Forsdahl SH, Solberg S, Singh K, Jacobsen BK. Abdominal aortic aneurysms, or a relatively large diameter of non-aneurysmal aortas, increase total and cardiovascular mortality: the Tromsø study. Int J Epidemiol 2009; 39:225-32. [PMID: 19897467 DOI: 10.1093/ije/dyp320] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In a population-based study in Tromsø, Norway, the authors assessed whether an abdominal aortic aneurysm (AAA) or the maximal infrarenal aortic diameter in a non-aneurismal aorta influence total and cardiovascular disease (CVD) mortality. METHODS A total of 6640 men and women, aged 25-84 years, were included in a 10-year mortality follow-up: 345 subjects with a diagnosed AAA and 6295 subjects with a non-aneurismal aorta. Non-aneurismal aortic diameter and prevalent AAAs were categorized into seven groups. RESULTS In subjects without an AAA, an aortic diameter > or =30 mm increased age- and sex-adjusted total mortality [mortality rate ratio (MRR) = 3.73, 95% confidence interval (CI) 1.77-7.89] and CVD mortality (MRR = 9.24, 95% CI 4.07-20.97) compared with subjects with aortic diameter of 21-23 mm. An AAA at screening was strongly associated with deaths from aortic aneurysm and was associated with total (MRR = 1.60, 95% CI 1.31-1.96) and CVD mortality (MRR = 2.41, 95% CI 1.81-3.21). This was not explained by deaths due to an AAA. Adjustments for CVD risk factors could fully explain the increased total, but not CVD mortality in subjects with an AAA. CONCLUSIONS An AAA increases total and CVD mortality. In the large majority of subjects with a non-aneurysmal aorta, the diameter does not influence total or CVD mortality. However, in individuals with a maximal diameter >26 mm (2% of the population), a positive relationship is found.
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Wang JA, Chen XF, Yu WF, Chen H, Lin XF, Xiang MJ, Fang CF, Du YX, Wang B. Relationship of heavy drinking, lipoprotein (a) and lipid profile to infrarenal aortic diameter. Vasc Med 2009; 14:323-9. [DOI: 10.1177/1358863x09104223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract The objective of this study was to examine the association of alcohol drinking and lipid profile with infrarenal aortic dimension. The diameter of the infrarenal aorta was measured using ultrasound in 395 individuals (mean 66.6 ± 10.3 years) with atherosclerotic diseases or risk factors. The associations between heavy drinking, serum lipoprotein (a) levels, lipid profile and infrarenal aorta diameters were examined. Heavy drinking and lipoprotein (a) were positively related with infrarenal aortic dimension, while low-density lipoprotein cholesterol (LDL-C)/high-density lipoprotein cholesterol (HDL-C), LDL-C and total cholesterol (TC)/HDL-C were negatively associated with infrarenal aortic diameter ( p < 0.05). In addition, there were negative associations of LDL-C/HDL-C, TC/HDL-C and positive associations of HDL-C and apolipoprotein AI (Apo AI) with heavy drinking ( p < 0.05). In conclusion, there was a positive association between infrarenal aortic diameters and heavy drinking, as well as lipoprotein (a) levels. Furthermore, the novel and unexpected inverse association between LDL-C/HDL-C, LDL-C, TC/HDL-C and abdominal aortic diameter may suggest a possible role for anti-atherogenic lipid profile (characterized by a higher level of HDL-C and lower level of LDL-C) in aortic dilatation processes, which need to be clarified by further studies.
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Affiliation(s)
- Jian-an Wang
- Department of Cardiovascular Diseases, No. 2 Affiliated Hospital, College of Medicine, Zhejiang University
| | - Xiao-feng Chen
- Department of Cardiovascular Diseases, No. 2 Affiliated Hospital, College of Medicine, Zhejiang University; Department of Cardiovascular Diseases, Taizhou Hospital, Wenzhou Medical College
| | - Wei-fang Yu
- Department of Cardiovascular Diseases and Department of Medical Ultrasonics, No. 2 Affiliated Hospital, College of Medicine, Zhejiang University
| | - Han Chen
- Department of Cardiovascular Diseases, No. 2 Affiliated Hospital, College of Medicine, Zhejiang University
| | - Xian-fang Lin
- Department of Cardiovascular Diseases, Taizhou Hospital, Wenzhou Medical College
| | - Mei-jiang Xiang
- Department of Cardiovascular Diseases, No. 2 Affiliated Hospital, College of Medicine, Zhejiang University
| | - Cong-feng Fang
- Department of Cardiovascular Diseases, Taizhou Hospital, Wenzhou Medical College
| | - Yu-xi Du
- Department of Cardiovascular Diseases, Taizhou Hospital, Wenzhou Medical College
| | - Bin Wang
- Department of Cardiovascular Diseases, Taizhou Hospital, Wenzhou Medical College
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Norman PE, Davis WA, Coughlan MT, Forbes JM, Golledge J, Davis TM. Serum carboxymethyllysine concentrations are reduced in diabetic men with abdominal aortic aneurysms: Health In Men Study. J Vasc Surg 2009; 50:626-31. [DOI: 10.1016/j.jvs.2009.05.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Revised: 05/27/2009] [Accepted: 05/27/2009] [Indexed: 11/24/2022]
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Parry DJ, Al-Barjas HS, Chappell L, Rashid T, Ariëns RAS, Scott DJA. Haemostatic and fibrinolytic factors in men with a small abdominal aortic aneurysm. Br J Surg 2009; 96:870-7. [PMID: 19591171 DOI: 10.1002/bjs.6632] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND : The presence of an abdominal aortic aneurysm (AAA) independently predicts cardiovascular disease (CVD) and its complications. Levels of plasma markers of fibrin turnover are raised in men with a large AAA (at least 5.5 cm) and predict CVD risk in healthy subjects. This study examined fibrin turnover in men with a small AAA. METHODS : Seventy-five men with a small AAA (30-55 mm) were compared with 90 controls matched for age, sex and race. Haemostatic and fibrinolytic parameters were assessed. RESULTS : Men with a small AAA had higher mean levels of fibrinogen (2.92 versus 2.59 g/l; P = 0.019), thrombin-antithrombin (TAT) complex (4.57 versus 1.89 ng/ml; P < 0.001), prothrombin F1 + 2 (1.13 versus 0.82 ng/ml; P = 0.004) and D-dimer (346.7 versus 120.2 ng/ml; P < 0.001). All markers correlated with maximum aortic diameter determined by ultrasonography. On multivariable regression the association between presence of an AAA and fibrinogen, TAT complex, prothrombin F1 + 2 and D-dimer levels remained significant after adjustment for confounding influences. CONCLUSION : Fibrin turnover was increased in these men with a small AAA, independently of concomitant CVD, conventional risk factors and inflammatory markers. Enhanced fibrin turnover may contribute to the risk of cardiac complications in this group.
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Affiliation(s)
- D J Parry
- Leeds Vascular Institute, The General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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van Bommel EFH, Jansen I, Hendriksz TR, Aarnoudse ALHJ. Idiopathic retroperitoneal fibrosis: prospective evaluation of incidence and clinicoradiologic presentation. Medicine (Baltimore) 2009; 88:193-201. [PMID: 19593223 DOI: 10.1097/md.0b013e3181afc420] [Citation(s) in RCA: 164] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Retroperitoneal fibrosis (RPF) is a rare disorder of unknown etiology. Its incidence is unknown, and the insidious and nonspecific nature of symptoms may contribute to considerable diagnostic delay. We conducted the current study to assess the incidence and clinicoradiologic characteristics of idiopathic RPF. For this, we evaluated prospectively 53 consecutive patients with a diagnosis of idiopathic RPF at our tertiary care referral center from April 1998 through January 2008.Calculated annual incidence of RPF was 1.3/100,000 inhabitants. Mean age was 64 +/- 11.1 (SD) yr; male-female ratio was 3.3:1.0. Median duration of symptoms was 6.0 mo (IQR 3.0-12.0). Abdominal, flank, and/or back pain and discomfort were the major symptoms, with visual analogue scale scores of 49 +/- 27.2 mm and 43 +/- 29.4 mm for pain and discomfort, respectively. Female patients had higher erythrocyte sedimentation rate (ESR), higher white blood cell count, and lower hemoglobin content than male patients at presentation. Computed tomography-documented maximal mass thickness amounted to 35 +/- 16.6 mm; craniocaudal length amounted to 137 +/- 48.8 mm. RPF mass extension up to or above the level of the renal vessels was noted in 3 patients (6%). Six patients (11%) presented with atypical RPF localization and/or bulky mass. Localized lymphadenopathy adjacent to the RPF mass was observed frequently (25%). Patients with hydronephrosis (56%) presented earlier than patients without hydronephrosis, with higher creatinine and greater mass thickness but similar pain severity. Patients were typically at high cardiovascular risk with increased-often aneurysmal-infrarenal aortic diameter (25.0 mm, IQR 22.0-30.0). RPF mass distribution was similar in patients with or without aneurysmal dilation. Occupational asbestos exposure (20%) and asbestos-related pleural changes (17%) were frequent among males. Previous or concurrent chronic inflammatory disease and/or autoimmune disease was noted in 8 patients (15%). Multivariate analysis revealed an independent association of ESR values with severity of pain and discomfort. Smoking was independently associated with infrarenal aortic diameter.In summary, annual RPF incidence is higher than previously assumed. Age at diagnosis and male-female ratio seem to have changed over time. RPF typically affects patients at high cardiovascular risk, including increased aortic diameter. Clinical presentation is influenced by sex, severity of inflammation and presence of hydronephrosis. Prolonged asbestos exposure and asbestos-related pleural changes were frequent among males. Localized lymphadenopathy adjacent to the RPF mass occurs frequently and should not confuse RPF diagnosis.
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Affiliation(s)
- E F H van Bommel
- From the Department of Internal Medicine (EFHVB, ALHJA) and Department of Radiology (IJ, TRH), Albert Schweitzer Hospital, Dordrecht, The Netherlands
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Baumgartner I, Hirsch AT, Abola MTB, Cacoub PP, Poldermans D, Steg PG, Creager MA, Bhatt DL. Cardiovascular risk profile and outcome of patients with abdominal aortic aneurysm in out-patients with atherothrombosis: Data from the Reduction of Atherothrombosis for Continued Health (REACH) Registry. J Vasc Surg 2008; 48:808-14. [DOI: 10.1016/j.jvs.2008.05.026] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 05/07/2008] [Accepted: 05/08/2008] [Indexed: 10/21/2022]
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