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Long term outcomes in men screened for abdominal aortic aneurysm: prospective cohort study.

Duncan JL, Harrild KA, Iversen L, Lee AJ, Godden DJ - BMJ (2012)

Bottom Line: The mortality risk in men with an aneurysm or with an aorta measuring 25-29 mm was significantly higher than in men with an aorta of ≤ 24 mm.The increased mortality risk in the 25-29 mm group was reduced when taking confounders such as smoking and known heart disease into account.After adjustment, compared with men with an aortic diameter of ≤ 24 mm, the risk of hospital admission for cardiovascular disease and chronic obstructive pulmonary disease was significantly higher in men with aneurysm and those with aortas measuring 25-29 mm.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Raigmore Hospital, Inverness IV2 3UJ, UK. john.duncan3@nhs.net

ABSTRACT

Objective: To determine whether there is a relation between aortic diameter and morbidity and mortality in men screened for abdominal aortic aneurysm.

Design: Prospective cohort study.

Setting: Highland and Western Isles (a large, sparsely populated area of Scotland).

Participants: 8146 men aged 65-74.

Main outcome measures: Morbidity and mortality in relation to presence of abdominal aortic aneurysm and three categories of aortic diameter (≤ 24 mm, 25-29 mm, and ≥ 30 mm).

Results: When screened, 414 men (5.1%) had an aneurysm (diameter ≥ 30 mm), 669 (8.2%) an aortic diameter of 25-29 mm, and 7063 (86.7%) an aortic diameter of ≤ 24 mm. The cohort was followed up for a median of 7.4 (interquartile range 6.9-8.2) years. Mortality was significantly associated with aortic diameter: 512 (7.2%) men in the ≤ 24 mm group died compared with 69 (10.3%) in the 25-29 mm group and 73 (17.6%) in the ≥ 30 mm group. The mortality risk in men with an aneurysm or with an aorta measuring 25-29 mm was significantly higher than in men with an aorta of ≤ 24 mm. The increased mortality risk in the 25-29 mm group was reduced when taking confounders such as smoking and known heart disease into account. After adjustment, compared with men with an aortic diameter of ≤ 24 mm, the risk of hospital admission for cardiovascular disease and chronic obstructive pulmonary disease was significantly higher in men with aneurysm and those with aortas measuring 25-29 mm. Men with an aneurysm also had an increased risk of hospital admission for cerebrovascular disease, atherosclerosis, peripheral arterial disease, and respiratory disease. In men with aortas measuring 25-29 mm, the risk of hospital admission with abdominal aortic aneurysm was significantly higher than in men with an aorta of ≤ 24 mm (adjusted hazard ratio 6.7, 99% confidence interval 3.4 to 13.2) and this increased risk became apparent two years after screening.

Conclusions: Men with abdominal aortic aneurysm and those with aortic diameters measuring 25-29 mm have an increased risk of mortality and subsequent hospital admissions compared with men with an aorta diameter of ≤ 24 mm. Consideration should be given to control of risk factors and to rescreening men with aortas measuring 25-29 mm at index scanning.

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Fig 2 Time to hospital admission for aortic aneurysm by aortic diameter
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fig2: Fig 2 Time to hospital admission for aortic aneurysm by aortic diameter

Mentions: Aortic diameter at screening was also associated with hospital admissions (table 3). The proportion of men with no subsequent hospital admission was 34.8% (n=2459) in the 24 mm or less group compared with 29.6% (n=198) in the 25-29 mm group and 16.9% (n=70) in the 30 mm or more group. Increasing aortic diameter at screening was associated with increased subsequent risk of admission for all circulatory disease (table 3 and fig 1). After adjustment for potential confounders, men with aortic diameters or more than 25 mm were at increased risk of hypertensive disease, ischaemic heart disease, and chronic obstructive pulmonary disease, whereas the increased risk of cerebrovascular disease, atherosclerosis, peripheral arterial disease, and diseases of the respiratory system was significant only in the 30 mm or more group. Compared with men with an aortic diameter of 24 mm or less, those with an aortic diameter of 25-29 mm had an increased risk of diabetes mellitus and of heart failure, but these risks were not found in men with an aneurysm. Lung cancer remained more common in the aneurysm group after adjustment. Men with an aneurysm at screening were over seven times more likely to have abdominal wall hernia or conditions such as intraperitoneal adhesions (table 3). Increasing aortic diameter at screening was associated with increasing risk of subsequent admission for aneurysm. For those in the 25-29 mm category, this became evident from two years after screening (fig 2).


Long term outcomes in men screened for abdominal aortic aneurysm: prospective cohort study.

Duncan JL, Harrild KA, Iversen L, Lee AJ, Godden DJ - BMJ (2012)

Fig 2 Time to hospital admission for aortic aneurysm by aortic diameter
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3344734&req=5

fig2: Fig 2 Time to hospital admission for aortic aneurysm by aortic diameter
Mentions: Aortic diameter at screening was also associated with hospital admissions (table 3). The proportion of men with no subsequent hospital admission was 34.8% (n=2459) in the 24 mm or less group compared with 29.6% (n=198) in the 25-29 mm group and 16.9% (n=70) in the 30 mm or more group. Increasing aortic diameter at screening was associated with increased subsequent risk of admission for all circulatory disease (table 3 and fig 1). After adjustment for potential confounders, men with aortic diameters or more than 25 mm were at increased risk of hypertensive disease, ischaemic heart disease, and chronic obstructive pulmonary disease, whereas the increased risk of cerebrovascular disease, atherosclerosis, peripheral arterial disease, and diseases of the respiratory system was significant only in the 30 mm or more group. Compared with men with an aortic diameter of 24 mm or less, those with an aortic diameter of 25-29 mm had an increased risk of diabetes mellitus and of heart failure, but these risks were not found in men with an aneurysm. Lung cancer remained more common in the aneurysm group after adjustment. Men with an aneurysm at screening were over seven times more likely to have abdominal wall hernia or conditions such as intraperitoneal adhesions (table 3). Increasing aortic diameter at screening was associated with increasing risk of subsequent admission for aneurysm. For those in the 25-29 mm category, this became evident from two years after screening (fig 2).

Bottom Line: The mortality risk in men with an aneurysm or with an aorta measuring 25-29 mm was significantly higher than in men with an aorta of ≤ 24 mm.The increased mortality risk in the 25-29 mm group was reduced when taking confounders such as smoking and known heart disease into account.After adjustment, compared with men with an aortic diameter of ≤ 24 mm, the risk of hospital admission for cardiovascular disease and chronic obstructive pulmonary disease was significantly higher in men with aneurysm and those with aortas measuring 25-29 mm.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Raigmore Hospital, Inverness IV2 3UJ, UK. john.duncan3@nhs.net

ABSTRACT

Objective: To determine whether there is a relation between aortic diameter and morbidity and mortality in men screened for abdominal aortic aneurysm.

Design: Prospective cohort study.

Setting: Highland and Western Isles (a large, sparsely populated area of Scotland).

Participants: 8146 men aged 65-74.

Main outcome measures: Morbidity and mortality in relation to presence of abdominal aortic aneurysm and three categories of aortic diameter (≤ 24 mm, 25-29 mm, and ≥ 30 mm).

Results: When screened, 414 men (5.1%) had an aneurysm (diameter ≥ 30 mm), 669 (8.2%) an aortic diameter of 25-29 mm, and 7063 (86.7%) an aortic diameter of ≤ 24 mm. The cohort was followed up for a median of 7.4 (interquartile range 6.9-8.2) years. Mortality was significantly associated with aortic diameter: 512 (7.2%) men in the ≤ 24 mm group died compared with 69 (10.3%) in the 25-29 mm group and 73 (17.6%) in the ≥ 30 mm group. The mortality risk in men with an aneurysm or with an aorta measuring 25-29 mm was significantly higher than in men with an aorta of ≤ 24 mm. The increased mortality risk in the 25-29 mm group was reduced when taking confounders such as smoking and known heart disease into account. After adjustment, compared with men with an aortic diameter of ≤ 24 mm, the risk of hospital admission for cardiovascular disease and chronic obstructive pulmonary disease was significantly higher in men with aneurysm and those with aortas measuring 25-29 mm. Men with an aneurysm also had an increased risk of hospital admission for cerebrovascular disease, atherosclerosis, peripheral arterial disease, and respiratory disease. In men with aortas measuring 25-29 mm, the risk of hospital admission with abdominal aortic aneurysm was significantly higher than in men with an aorta of ≤ 24 mm (adjusted hazard ratio 6.7, 99% confidence interval 3.4 to 13.2) and this increased risk became apparent two years after screening.

Conclusions: Men with abdominal aortic aneurysm and those with aortic diameters measuring 25-29 mm have an increased risk of mortality and subsequent hospital admissions compared with men with an aorta diameter of ≤ 24 mm. Consideration should be given to control of risk factors and to rescreening men with aortas measuring 25-29 mm at index scanning.

Show MeSH
Related in: MedlinePlus