Long-term incidence of myocardial infarct, stroke, and mortality in patients operated on for abdominal aortic aneurysms. 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. Thrombus volume is associated with cardiovascular events and aneurysm growth in patients who have abdominal aortic aneurysms. High-risk and low-risk screening for abdominal aortic aneurysm both reduce aneurysm-related mortality. A stratified analysis from a single-centre randomised screening trial. Prevalence of abdominal aortic aneurysms and its relation with cardiovascular risk stratification: protocol of the Risk of Cardiovascular diseases and abdominal aortic Aneurysm in Varese (RoCAV) population based study Traditional and novel risk factors for clinically diagnosed abdominal aortic aneurysm: the Kaiser multiphasic health checkup cohort study. Cognitive-behavioral treatment of women's body-image dissatisfaction. Early and late outcome of surgical repair for small abdominal aortic aneurysms: a population-based analysis. Serum carboxymethyllysine concentrations are reduced in diabetic men with abdominal aortic aneurysms: Health In Men Study. Endovascular aneurysm repair at 5 years: Does aneurysm diameter predict outcome? Prevalence of abdominal aortic aneurysm and large infrarenal aorta in patients with acute coronary syndrome and proven coronary stenosis: a prospective monocenter study. The fate of patients undergoing surveillance of small abdominal aortic aneurysms. A randomized controlled trial of endovascular aneurysm repair versus open surgery for abdominal aortic aneurysms in low- to moderate-risk patients. Smoking, hypertension, alcohol consumption, and risk of abdominal aortic aneurysm in men. Abdominal Aortic Aneurysm or Aortic Occlusive Disease: Role of Trace Element Imbalance Abdominal aortic aneurysm and aortic occlusive disease: a comparison of risk factors and inflammatory response. Screening for abdominal aortic aneurysm: lessons from a population-based study. Computed tomography scanning findings associated with rapid expansion of abdominal aortic aneurysms. The impact of hemodynamic status on outcomes of endovascular abdominal aortic aneurysm repair for rupture. Intermittent Roxithromycin for Preventing Progression of Small Abdominal Aortic Aneurysms: Long-Term Results of a Small Clinical Trial Preliminary ten year results from a randomised single centre mass screening trial for abdominal aortic aneurysm. Ruptured versus Elective Abdominal Aortic Aneurysm Repair: Outcome and Cost Is screening for abdominal aortic aneurysm acceptable to the population? Selection and recruitment to hospital-based mass screening for abdominal aortic aneurysm. The strange relationship between diabetes and abdominal aortic aneurysm. Quantifying the risks of hypertension, age, sex and smoking in patients with abdominal aortic aneurysm Frequency of abdominal aortic aneurysm in patients undergoing coronary artery bypass grafting. Screening for Abdominal Aortic Aneurysm: US Preventive Services Task Force Recommendation Statement. Growth rate and associated factors in small abdominal aortic aneurysms. Prevalence and Associations of Abdominal Aortic Aneurysm Detected through Screening Selective screening for abdominal aortic aneurysms with physical examination and ultrasound.
OBJECTIVE The risks of myocardial infa rct ion ( MI ) and stroke after abdominal aortic aneurysm ( AAA ) resection are not known . Prophylaxis with aspirin and statins is not generally recommended , although patients with AAAs have an increased prevalence of cardiovascular atherosclerosis . We report the incidences of MI , stroke , and death in an unselected national cohort of patients operated on for AAAs , with the general population as the control group . METHODS In a matched cohort study , 11,094 Danish patients who underwent acute or elective open AAA repair from January 1986 through June 2009 were compared with four r and omly chosen age- and sex-matched individuals ( controls ) from the general population ( n = 44,364 ) . Data were collected retrospectively from the Danish Vascular Registry ( Karbase ) , the National Population Registry , and the National Inpatient Registry . The groups were analyzed for the incidences of MI , stroke , and death , with up to 20 years of follow-up . RESULTS AAA patients had an annual MI incidence of 2.5 % ( hazard ratio , 2.1 ; 95 % confidence interval [ CI ] , 1.9 - 2.2 ) compared with the general population . The annual incidence of stroke was 2.9 % ( hazard ratio , 1.8 ; 95 % CI , 1.6 - 1.9 ) , and there was a 2.4-fold ( 95 % CI , 2.3 - 2.4 ) increase in the hazard of all-cause mortality compared with the general population . CONCLUSION AAA patients of both sexes have a high risk of atherosclerotic events ( MI , stroke ) and death , so lifelong prophylaxis must be considered from our epidemiologic data . R and omized trials investigating the potential benefit of aspirin and statin therapy in AAA patients are needed OBJECTIVE Data sets regarding patients with abdominal aortic aneurysm ( AAA ) have almost universally been restricted to single geographic regions . We aim ed to obtain data on the risk factor profile and cardiovascular ( CV ) co-morbidity among multi-ethnic patients with known AAA in the global REACH ( REduction of Atherothrombosis for Continued Health ) Registry . METHODS The REACH Registry is an international , prospect i ve , observational out-patient registry enrolling out- patients > /=45 years of age with established coronary artery disease ( CAD ) , cerebrovascular disease ( CVD ) or peripheral arterial disease ( PAD ) or with at least three atherothrombotic risk factors . This report includes observations pertaining to 68,236 out- patients enrolled in 44 countries . MAIN OUTCOME MEASURES Gender , ethnic origin , CV risk factors , established atherosclerotic disease ( CAD , CVD and PAD ) at baseline , and CV outcome events at 1-year were compared in patients with and without AAA . RESULTS An AAA was reported in 1722 ( 2.5 % ) of 68,236 out- patients enrolled in the REACH Registry . Older age ( 73 + /- 8 vs 68 + /- 10 , P < .0001 ) , male gender ( 81 % vs 63 % , P < .0001 ) , White ethnicity ( 79 % vs 67 % , P < .0001 ) and a history of smoking ( 81 % vs 55 % , P < .0001 ) were independently related to the diagnosis of AAA . There was a weaker association with hypertension or hypercholesterolemia , and an inverse relation with diabetes . Fatal and non-fatal coronary and cerebrovascular event rates were not different between the AAA and non-AAA cohorts , but individuals with AAA suffered increased rates of other cardiovascular deaths ( 1.39 % vs 0.94 % , P = .0135 ) , hospitalizations for atherothrombotic events ( 14.1 % vs 9.3 % , P < .0001 ) due to increased rates of revascularization procedures , and new or worsening PAD ( 3.7 % vs 1.3 % , P < .0001 ) at 1-year follow-up . CONCLUSION This study , the largest published to date , presents the CV risk profile and outcome of patients with an established diagnosis of AAA from a cohort of patients with either overt manifestations of CV disease or multiple risk factors , and further defines these patients in a multi-ethnic , global context 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 prospect ively 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 vali date d technique . Patients were monitored prospect ively for a median of 3 years ( interquartile range [ IQR ] , 2.0 - 3.6 years ) , and cardiovascular events ( nonfatal stroke , nonfatal myocardial infa rct ion , 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 BACKGROUND Cardiovascular diseases and chronic obstructive pulmonary disease ( COPD ) are both associated with abdominal aortic aneurysms ( AAA ) . The aim of this study was therefore to analyse whether screening for AAA could be restricted to men with such diseases ( high risk group ) . METHODS Before the date of r and omisation of a population screening trial of 12,639 64 - 73-year-old males , all discharge diagnoses from the National Patient Registry concerning AAA-related diseases were merged with the screening results on attendance , AAA prevalence , and AAA-related mortality and overall mortality . Differences in proportions were compared by Chi square tests and differences in mortality by Cox regression analyses . RESULTS The attendance rate was 78.8 % and 6.7 % had an AAA in the high risk group compared to 75.8 % attendance ( P<0.001 ) and 2.9 % ( P<0.001 ) in the remaining population . Cumulatively , screening of only high risk men with would have required 72.9 % ( 95 % C.I. : 72.3 - 74.5 % ) fewer screening invitations , would have discovered 46.1 % ( 95 % C.I. : 38.9 - 53.4 % ) of the AAA cases diagnosed and prevented 46.7 % ( 95 % C.I. : 28.3 - 65.7 % ) of the AAA-related deaths . However , screening decreased AAA-related mortality both among men with and without known COPD or cardiovascular diseases : mortality ratio : 0.22 ( 95 % C.I. : 0.08 - 0.65 ) , P=0.006 , and 0.24 ( 95 % C.I : 0.09 - 0.63 , P=0.004 , respectively . CONCLUSION High-risk population screening would prevent less than half of AAA-related deaths . Therefore , restricting screening to such high-risk groups does not seem justified , but cost effectiveness analyses are needed to reach a firm conclusion Background Recent meta-analyses suggested that screening program for abdominal aortic aneurysms ( AAA ) in 65-year old males is cost-effective at prevalence of about 1 % . Since some events occur also in females and among the youngers , screening could be feasible among those at higher risk , such as smokers or individuals with a family history of AAA . The RoCAV ( Risk of Cardiovascular diseases and abdominal aortic Aneurysms in Varese ) Project is a population -based study aim ed to evaluate AAA prevalence in Northern Italy in males over-65 years as well as among females and younger males , and to identify new markers for risk stratification by collecting a large set of CVD risk factors . The aims of the project are : ( i ) cross-sectional evaluation of AAA prevalence ( ii ) ; evaluation of st and ard CVD risk score as criteria for selecting subgroup at higher risk to be included in a screening program ; ( iii ) identification of new risk markers and risk score algorithm for AAA and CVD risk stratification ; ( iv ) cost-effective evaluation during the follow-up . Methods Males aged 50–75 years and females aged 60–75 years , resident in the city of Varese ( Lombardy Region ) , were r and omly selected from the civil registry . Among 5198 successfully invited , 3777 subjects accepted to participate and were finally recruited ( participation rate 63.8 % ) from June 2013 to May 2016 . Trained operators administered a computerized anamnestic question naire , measured anthropometric parameters ( BMI , body circumferences , skinfolds ) , blood pressure , ankle-brachial index , pulse wave velocity and performed abdominal aortic ultrasound scan , ECG and spirometry .  All methods were internationally vali date d. A blood sample was collected and stored in biobank . A follow-up will be carried out through linkage with electronic records . Discussion Participation rate and data quality assessment were as expected and will reasonably allow to reach the project aims . The expected impact in public health of the RoCAV project will be the potential implementation of a AAA screening program to the whole region as well as the formulation of new criteria for risk assessment of AAA and CVD BACKGROUND Identification of risk factors for and early diagnosis of clinical ly significant abdominal aortic aneurysm ( AAA ) before rupture is vital to optimize outcomes in these patients . Our aim was to examine traditional and three novel potential risk factors ( abdominal obesity , white blood cell count , and kidney function ) for abdominal aortic aneurysm ( AAA , comprising discharge diagnosis or surgical repair ) in a large multiethnic population . METHODS  Cohort study ( N = 104,813 ) conducted at an integrated health care delivery system in northern California . RESULTS After a median of 13 years , 605 AAA events ( 490 in men and 115 in women ; 91 [ 15 % ] fatal ) were observed . In multivariable analysis , factors significantly associated with risk of clinical ly detected AAA included male gender , older age , black race ( inversely ) , low educational attainment , cigarette smoking ( with dose-response relation ) , height , treated and untreated hypertension , high total serum cholesterol , elevated white blood cell count , known coronary artery disease , history of intermittent claudication , and reduced kidney function . A significant Asian race by gender interaction was found such that Asian race had a ( borderline significant ) protective association with AAA in men but not in women . CONCLUSIONS Our findings confirm that major atherosclerotic risk factors , except for diabetes and obesity , are also prospect ively related to AAA and suggest that elevated white blood cell count and reduced kidney function may improve risk stratification for clinical ly relevant AAA Body-image dissatisfaction is a problem that affects a substantial minority ofwomen and cuts across various diagnostic groups . College women with a significant level ofbody-image dissatisfaction were r and omly assigned to either a cognitive-behavioral treatment ( CBT ) program  ( n = 15 ) or to a waiting-list control group  ( n = 16 ) . The CBT program consisted of six structured , individual sessions that applied cognitive-behavioral procedures to the problem of negative body image . At pretest , posttest , and 7-week foUow-up , multiple aspects of body image and other areas of psychosocial functioning were assessed . Relative to the control condition , the CBT program successfully improved affective body image , weakened maladaptive body-image cognitions , and enhanced social self-esteem and feelings about physical fitness and sexuality . Treatment effects were largely maintained at followup . After posttest , the control group received a 3-week treatment with immediate effects that generally replicated those obtained in the 6-wer program PURPOSE Whether small abdominal aortic aneurysms ( AAAs ) ( < or = 5 cm in diameter ) should be repaired early to enhance late survival remains controversial . Long-term population -based data on the surgical outcome for small AAAs may help to establish practice guidelines until r and omized clinical trials are completed . METHODS To examine an entire community experience with small AAAs , we conducted a population -based analysis of the recognition , reasons for operation , perioperative mortality rates , and late survival  in Olmsted County , Minnesota . RESULTS The incidence of recognized small AAAs increased thirtyfold during a 30-year period . The propensity to repair small AAAs also increased during the same period . Eventually one third of small AAAs were repaired . The primary reasons for surgical consultation and operation were presence of the aneurysm ( 49 % ) , expansion on serial examination ( 28 % ) , nonspecific abdominal or back symptoms ( 18 % ) , and excessive patient anxiety about the aneurysm ( 5 % ) . Community operative mortality rates for small AAAs were low ( 2.6 % ) compared with those for large aneurysms ( 5.5 % ) ( p = 0.65 ) . However , the observed 5-year survival rate for the group undergoing repair of small aneurysms was 62 % , which was significantly less than the 83 % expected survival for the general population ( p < 0.05 ) . Relative survival for the operated small and large aneurysms was similar . The primary cause of death for both groups was myocardial infa rct ion . CONCLUSIONS The results of our population -based analysis indicate that early operative results for elective repair of small AAAs are excellent , but late survival remains significantly impaired by coronary heart disease . Consequently , our data question whether early repair of small AAAs will enhance late survival . Until r and omized clinical trials on management of small AAAs are completed , most small AAAs should be monitored for expansion and operated on electively when they approach or enter the range of 5 to 6 cm in good-risk patients OBJECTIVE Abdominal aortic aneurysms ( AAAs ) share common risk factors with atherosclerosis , except for diabetes which appears protective . The reason for this is unknown . Although increased circulating concentrations of advanced glycation endproducts ( AGEs ) such as carboxymethyllysine ( CML ) are associated with occlusive vascular disease , it is possible that their effects on the aortic wall explain the paradoxically low incidence of AAAs in diabetes . METHODS We studied 234 community-dwelling men aged 65 to 79 years . The cases comprised all identifiable diabetic men with AAA ( aortic diameter > or = 30 mm on ultrasound ; n = 27 ) and r and omly-selected non-diabetic men with AAA ( n = 67 ) . Controls were age-matched r and omly-selected diabetic men ( n = 69 ) and age-matched r and omly-selected non-diabetic men ( n = 71 ) without AAA ( aortic diameter 18 to 22 mm ) .  Serum CML concentrations were measured by vali date d indirect enzyme-linked immunosorbent assay ( ELISA ) . RESULTS Serum CML concentrations were significantly lower in men with AAAs than those without ( 6627 + /- 1544 vs 7309 + /- 1490 nmol/mol lysine ; P = .001 ) . Variables positively associated with AAA were height , diastolic blood pressure , smoking , a history of coronary heart disease , and serum creatinine ( P < or = .040 ) , while serum CML ( odds ratio [ 95 % confidence interval ] per 1000 nmol/mol lysine ; 0.80 [ 0.64 - 0.98 ] ) and a history of diabetes were inversely associated ( P < or = .040 ) . After adjusting , the interaction between diabetes status and serum CML was negatively associated with AAA ( P = .016 ) . CONCLUSION These cross-sectional data show that circulating concentrations of CML are reduced in diabetic men with AAAs . This is in contrast to studies of the relationship between AGEs and occlusive manifestations of cardiovascular disease and could explain the inverse association between diabetes and AAA OBJECTIVE The appropriate size threshold for endovascular repair of small abdominal aortic aneurysms ( AAA ) is unclear . We studied the outcome of endovascular aneurysm repair ( EVAR ) as a function of preoperative aneurysm diameter to determine the relationship between aneurysm size and long-term outcome of endovascular repair . METHODS We review ed the results of 923 patients treated in a prospect i ve , multicenter clinical trial of EVAR . Small aneurysms were defined according to two size thresholds of 5.5 cm and 5.0 cm . Two-way analysis was used to compare patients with small aneurysms ( < 5.5 cm , n = 441 ) to patients with large aneurysms ( > or = 5.5 cm , n = 482 ) . An ordered three-way analysis was used to compare patients with small AAA ( < 5.0 cm , n = 145 ) , medium AAA ( 5.0 to 5.9 cm , n = 461 ) , and large AAA ( > or = 6.0 cm , n = 317 ) . The primary outcome measures of rupture , AAA-related death , surgical conversion , secondary intervention , and survival were compared using Kaplan-Meier estimates at 5 years . RESULTS Median aneurysm size was 5.5 cm . The two-way comparison showed that 5 years after EVAR , patients with small aneurysms ( < 5.5 cm ) had a lower AAA-related death rate ( 1 % vs 6 % , P = .006 ) , a higher survival rate ( 69 % vs 57 % , P = .0002 ) , and a lower secondary intervention rate ( 25 % vs 32 % , P = .03 ) than patients with large aneurysms ( > or = 5.5 cm ) . Three-way analysis revealed that patients with small AAAs ( < 5.0 cm ) were younger ( P < .0001 ) and were more likely to have a family history of aneurysm ( P < .05 ) , prior coronary intervention ( P = .003 ) , and peripheral occlusive disease ( P = .008 ) than patients with larger AAAs . Patients with smaller AAAs also had more favorable aortic neck anatomy ( P < .004 ) . Patients with large AAAs were older ( P < .0001 ) , had higher operative risk ( P = .01 ) , and were more likely to have chronic obstructive pulmonary disease ( P = .005 ) , obesity ( P = .03 ) , and congestive heart failure ( P = .004 ) . At 5 years , patients with small AAAs had better outcomes , with 100 % freedom from rupture vs 97 % for medium AAAs and 93 % for large AAAs ( P = .02 ) , 99 % freedom from AAA-related death vs 97 % for medium AAAs and 92 % for large AAAs ( P = .02 ) and 98 % freedom from conversion vs 92 % for medium AAAs and 89 % for large AAAs ( P = .01 ) . Survival was significantly improved in small ( 69 % ) and medium AAAs ( 68 % ) compared to large AAAs ( 51 % , P < .0001 ) . Multivariate Cox proportional hazards modeling revealed that aneurysm size was a significant independent predictor of rupture ( P = .04 ; hazard ratio [ HR ] , 2.195 ) , AAA-related death ( P = .03 ; HR , 2.007 ) , surgical conversion ( P = .007 ; HR , 1.827 ) , and survival ( P = .001 ; HR , 1.351 ) . There were no significant differences in secondary intervention , endoleak , or migration rates between small , medium , and large AAAs . CONCLUSIONS Preoperative aneurysm size is an important determinant of long-term outcome following endovascular repair . Patients with small AAAs ( < 5.0 cm ) are more favorable c and i date s for EVAR and have the best long-term outcomes , with 99 % freedom from AAA death at 5 years . Patients with large AAAs ( > or = 6.0 cm ) have shorter life expectancy and have a higher risk of rupture , surgical conversion , and aneurysm-related death following EVAR compared to patients with smaller aneurysms . Nonetheless , 92 % of patients with large AAAs are protected from AAA-related death at 5 years . Patients with AAAs of intermediate size ( 5 to 6 cm ) represent most of the patients treated with EVAR and have a 97 % freedom from AAA-related death at 5 years BACKGROUND Little is known about the prevalence of abdominal aortic aneurysm ( AAA ) in patients with coronary heart disease . The aims of this prospect i ve study were to evaluate the prevalence of AAA and of large abdominal aorta in patients hospitalized for acute coronary syndrome and coronary stenosis of 50 % or greater . METHODS AAA ultrasound screening was prospect ively performed in 306 patients after they gave informed consent . AAA and large abdominal aorta were defined by maximum anteroposterior diameter of 30 mm or greater and of 20 to 29 mm , respectively . Patient characteristics were prospect ively collected . Univariate and multivariate analyses were used to identify risk factors for AAA and large abdominal aorta . A p value < 0.05 was considered statistically significant . RESULTS AAAs were diagnosed in 20 patients ( 6.6 % ) . Mean diameter was 33 + /- 3.7 mm , and median diameter [ min -- max ] was 31 mm [ 30 - 45 mm ] . All except one AAA were between 30 and 40 mm . No AAAs were detected in patients younger than 50 years . Prevalence reached 7.7 % in patients older than 50 years . Using stepwise logistic regression analysis , age ( odds ratio [ OR ] 1.04 . 95 % confidence [ CI ] 1.00 - 1.09 per year of age , p = 0.06 ) and previous coronary events ( OR 2.44 , 95 % CI 0.96 - 6.25 , p = 0.06 ) showed a borderline significant association with AAA . Large infrarenal aortic diameter was observed in 32 % of patients . Age ( OR 1.03 , 95 % CI 1.02 - 1.05 per year of age , p < 0.0001 ) , male gender ( OR 16.7 , 95 % CI 6.25 - 50.0 , p < 0.0001 ) , and overweight ( OR 2.0 , 95 % CI 1.2 - 3.4 , p = 0.01 ) showed a significant independent association with large aorta . CONCLUSION AAA and large infrarenal aorta prevalence seems high in patients with acute coronary syndrome and proven coronary stenosis of 50 % or greater . Previous coronary events and older age might be associated with higher risk of AAA , and age , male gender , and obesity are significantly associated with large infrarenal aorta . If these results are confirmed in larger studies , further guidelines concerning AAA screening in this well-defined population should be considered OBJECTIVES Increasing numbers of patients with small abdominal aortic aneurysms ( AAA ) are being diagnosed . The aim of this paper is to define the fate of those patients undergoing surveillance of small AAAs .  SETTING U.K. district general hospital . METHODS A prospect i ve study has been carried out of all patients undergoing surveillance .  At the time of the first consultation the patient was assessed , a Detsky score calculated and the referral source noted . End points of the study were elective repair of the aneurysm , aneurysm rupture or death of the patient . RESULTS Details of 267 patients were analysed . The referral source was general practitioner in 39 % , patients with peripheral vascular disease in 32 % and department of urology in 21 % . None were referred from population screening . The cumulative 5-year risks of rupture , elective repair or non-AAA related deaths were 15 % , 26 % and 46 % for all patients , 4 % , 13 % and 38 % for patients initially presenting with AAA less than 4 cm diameter and 21 % , 42 % and 54 % for patients presenting with an AAA 4 - 5.5 cm diameter . All but one of 11 patients whose aneurysm ruptured were unfit or had declined elective repair . There were 56 non-AAA related deaths , the majority due to cardiovascular causes . Those patients with low Detsky scores had a 5-year survival of 62 % , those with high scores 44 % . The age/sex matched survival or a normal population at 5 years in 80 % . CONCLUSION Overall the non-AAA related mortality was greater than the risks of rupture or elective repair . It is important to bear in mind the poor prognosis of this group of patients compared with a normal population when considering elective repair of small AAAs BACKGROUND Several studies , including three r and omized controlled trials ( RCTs ) , have shown that endovascular repair ( EVAR ) of abdominal aortic aneurysms ( AAA ) offered better early results than open surgical repair ( OSR ) but a similar medium-term to long-term mortality and a higher incidence of re interventions . Thus , the role of EVAR , most notably in low-risk patients , remains debated . METHODS The ACE ( Anevrysme de l'aorte abdominale : Chirurgie versus Endoprothese ) trial compared mortality and major adverse events after EVAR and OSR in patients with AAA anatomically suitable for EVAR and at low-risk or intermediate-risk for open surgery . A total of 316 patients with > 5 cm aneurysms were r and omized in institutions with proven expertise for both treatments : 299 patients were available for analysis , and 149 were assigned to OSR and 150 to EVAR . Patients were monitored for 5 years after treatment . Statistical analysis was by intention to treat . RESULTS With a median follow-up of 3 years ( range , 0 - 4.8 years ) , there was no difference in the cumulative survival free of death or major events rates between OSR and EVAR : 95.9 % ± 1.6 % vs 93.2 % ± 2.1 % at 1 year and 85.1 % ± 4.5 % vs 82.4 % ± 3.7 % at 3 years , respectively ( P = .09 ) . In-hospital mortality ( 0.6 % vs 1.3 % ; P = 1.0 ) , survival , and the percentage of minor complications were not statistically different . In the EVAR group , however , the crude percentage of reintervention was higher ( 2.4 % vs 16 % , P < .0001 ) , with a trend toward a higher aneurysm-related mortality ( 0.7 % vs 4 % ; P = .12 ) . CONCLUSIONS In patients with low to intermediate risk factors , open repair of AAA is as safe as EVAR and remains a more durable option Despite the known protective association between moderate alcohol consumption and ischemic heart disease , little is known about the effects of alcohol consumption on abdominal aortic aneurysms ( AAA ) . The authors analyzed prospect i ve , biennially up date d data for a cohort of 39,352 US men from 1986 to 2002 . The association of incident AAA diagnosis with alcohol consumption in grams per day was assessed at baseline and by using alcohol consumption data up date d every 4 years , controlling for previously reported cardiovascular risk factors . During 576,374 person-years of follow-up , 376 newly diagnosed cases of AAA were demonstrated . After adjustment for other risk factors for AAA , including smoking , hypertension , and body mass index , alcohol consumption at baseline was independently associated with AAA diagnosis ( p for trend = 0.03 ) , with a maximum hazard ratio of 1.21 ( 95 % confidence interval : 0.78 , 1.87 ) for > or = 30.0 g ( approximately > or = 2 st and ard drinks ) of daily alcohol consumption . This association was stronger when the up date d alcohol consumption data were assessed rather than simply baseline exposure ( p for trend = 0.02 ) ; the hazard ratio for the highest level of intake ( > or = 30.0 g/day ) was 1.65 ( 95 % confidence interval : 1.03 , 2.64 ) . Small numbers limited analyses by beverage type , but liquor demonstrated the strongest positive association with AAA The nature of the relationship between atheromatous disease and degenerative aneurysm is yet to be defined . The purpose of this study was to compare tissue Fe , Cu , Zn , and thiobarbituric acid reactive substances ( TBARS ) levels ( as a marker of lipid peroxidation ) in the abdominal aorta in relation to the development of aneurysmal and occlusive disease in the infrarenal aorta . This was a prospect i ve clinical study in an institutional referral center , in hospitalized patients . Eighty male patients who underwent surgery for abdominal aortic aneurysm ( AAA ) or aortic occlusive disease ( AOD ) were included in the study . Age , risk factors and comorbid conditions were recorded , including diabetes mellitus , hypertension , coronary artery disease , smoking , and chronic obstructive pulmonary disease . Aortic wall biopsies were collected at operation from the anterolateral section of the infrarenal aorta . Tissue Fe , Cu , Zn , and TBARS levels were determined . The mean age of the AAA group was 66.2 ( 56—75 ) years and of the AOD group 57.8 ( 47—72 ) years ( p < 0.001 ) . There was a higher prevalence of hypertension in AAA patients compared to AOD patients ( 62.5 % , 35 % respectively ; p < 0.05 ) . The comparison of tissue Zn levels showed no significant difference . Tissue levels of Fe , Cu , and TBARS were found to be higher in the AAA group , compared with the AOD group ( p<0.001 for each ) . These results suggest that higher oxidative stress as a result of higher Fe and Cu levels in the AAA , compared with AOD , may be one of the contributing factors in aneurysmal formation as a result of promoted wall erosion OBJECTIVE to compare patients with abdominal aortic aneurysm ( AAA ) and aortic occlusive disease ( AOD ) with regard to risk factors for atherosclerosis , co-morbid conditions and inflammatory activity . PATIENTS AND METHODS a total of 155 patients undergoing abdominal aortic surgery between January 1993 and October 1997 : 82 ( 53 % ) had aneurysmal disease and 73 ( 47 % ) had occlusive disease . Principal risk factors were compared : age ; gender ; smoking ; hypertension ; hyperlipidaemia ; diabetes mellitus ; severe peripheral vascular disease ( PVD ) and ischaemic heart disease . Aortic wall tissue sample s were obtained during surgery . A prospect i ve blind analysis was performed for the presence of inflammatory cytokines TNF-alpha , IL-1 beta , IL-6 and TGF-beta . RESULTS the average age of AAA patients was 74 years ( 50 - 88 ) , while that of AOD patients was 61 years ( 43 - 82 ) ( p<0.0001 ) . Diabetes mellitus was found to be much more prevalent in the AOD group ( p<0.001 ) , while hypertension and severe PVD were more prevalent in the AAA group ( p<0.001 ) . No differences were found concerning any of the risk factors . Inflammatory cytokine activity : AAA tissue sample s contained significantly higher mean TNF-alpha and IL-6 levels compared to the AOD sample s ( 5.6+/-2.7 x 10 E-4 vs. 4.4+/-2.7 x 10 E-5 atmoles/microl ( p=0 . 01 ) , and 0.6+/-0.4 vs. 0.01+/-0.006 atmoles/microl ( p=0.02 ) respectively ) . No differences were found related to IL-1 beta and TGF-beta . CONCLUSIONS ( 1 ) Patients with AAA have fewer atherosclerotic risk factors than do patients with AOD . ( 2 ) Patients with AAA and AOD have significantly different inflammatory activity . ( 3 ) The data supports the hypothesis that AAA and AOD are probably two different pathological entities OBJECTIVES To test the acceptability of screening and to identify modifiable risk factors for abdominal aortic aneurysm ( AAA ) in men . DESIGN A trial of ultrasound screening for AAA in a population -based r and om sample of men aged 65 - 83 years , and a cross-sectional case-control comparison of men in the same sample . PARTICIPANTS 12,203 men who had an ultrasound examination of their abdominal aorta , and completed  a question naire covering demographic , behavioural and medical factors . MAIN OUTCOME MEASURES Prevalence of AAA , and independent associations of AAA with demographic , medical and lifestyle factors . RESULTS Invitations to screening produced a corrected response of 70.5 % . The prevalence of AAAs ( > 30 mm ) rose from 4.8 % in men aged 65 - 69 years to 10.8 % in those aged 80 - 83 years . The overall prevalence of large ( > 50 mm ) aneurysms was 0.69 % . In a multivariate logistic model Mediterranean-born men had a 40 % lower risk of AAA ( > 30 mm ) compared with men born in Australia ( odds ratio [ OR ] , 0.6 ; 95 % CI , 0.4 - 0.8 ) , while ex-smokers had a significantly increased risk of AAA ( OR , 2.3 ; 95 % CI , 1.9 - 2.8 ) , and current smokers had even higher risks . AAA was significantly associated with established coronary and peripheral arterial disease and a waist : hip ratio greater than 0.9 ; men who regularly undertook vigorous exercise had a lower risk ( OR , 0.8 ; 95 % CI , 0.7 - 1.0 ) . CONCLUSION Ultrasound screening for AAA is acceptable to men in the likely target population . AAA shares some but not all of the risk factors for occlusive vascular disease , but the scope for primary prevention of AAA in later life is limited PURPOSE Early repair of abdominal aortic aneurysms ( AAA ) is particularly appropriate for those that are most likely to exp and . Our aim was to define features on computed tomography ( CT ) scanning associated with subsequent rapid aneurysm expansion . METHODS We review ed CT scans of 80 patients with AAA ( > 3.0 cm ) who underwent CT scanning of the abdomen and pelvis two times , at least 6 months apart , between 1986 and 1992 . The aneurysms initially measured 4.4 + /- 0.6 cm , and the mean interval between obtaining scans was 22 + /- 12 months . Clinical variables assessed included age , sex , medical risk factors , underlying cardiovascular and pulmonary diseases , and administration of beta blockers and lipid-lowering agents . Computer-aided measurements on each CT scan section included the maximal and minimal diameters and area of the aneurysm . Dimensions of the luminal thrombus and the arc of aneurysm wall covered by thrombus ( TARC ) . Maximal aneurysm dimensions were related to juxtarenal aortic and second lumbar vertebral body dimensions . RESULTS Mean aneurysm expansion was 0.26 + /- 0.25 cm/yr . CT scanning variables that correlated significantly with rate of expansion included the mean TARC ( r = 0.43 , p < 0.001 ) , thrombus volume fraction ( r = 0.37 , p < 0.001 ) , TARC on the largest aneurysm cross section ( r = 0.34 , p < 0.01 ) , and thrombus area fraction ( r = 0.30 , p < 0.01 ) . Rapid expansion ( > 0.5 cm/yr ) occurred in 15 ( 19 % ) aneurysms . The two predictors for rapid expansion on logistic regression analysis were mean TARC ( p < 0.005 ) and the presence of carotid artery disease ( p < 0.05 ) . CONCLUSION An increased AAA thrombus load is associated with a higher likelihood of rapid expansion and should weigh in favor of early surgical repair OBJECTIVE To date , there are no published reports comparing hemodynamically (Hd)-stable and Hd-unstable patients with ruptured abdominal aortic aneurysms ( r-AAAs ) undergoing endovascular aneurysm repair ( EVAR ) . This study evaluates outcomes of EVAR for r-AAA based on patient 's Hd status METHODS From 2002 to 2011 , 136 patients with r-AAAs underwent EVAR  and were categorized into two groups based on systolic blood pressure ( SBP ) measurements before EVAR : 92 ( 68 % ) Hd-stable ( SBP ≥ 80 mm Hg ) and 44 ( 32 % ) Hd-unstable ( SBP < 80 mm Hg for > 10 minutes ) . All data were prospect ively entered in a data base and retrospectively analyzed . Outcomes included 30-day mortality , postoperative complications , the need for secondary re interventions , and midterm mortality . The effect of potential predictors on 30-day mortality was assessed by χ(2 ) and logistic regression . RESULTS Of the 136 r-AAA patients with EVAR , the Hd-stable and Hd-unstable groups had similar comorbidities ( coronary artery disease , 63 % vs 59 % ; hypertension , 72 % vs 75 % ; chronic obstructive pulmonary disease , 21 % vs 26 % ; and chronic renal insufficiency , 18 % vs 18 % ) , mean AAA maximum diameter ( 6.6 vs 6.4 cm ) , need for on-the-table conversion to open surgical repair ( 3 % vs 7 % ) , and incidences of nonfatal complications ( 43 % vs 38 % ) and secondary interventions ( 23 % vs 25 % ) . Preoperative computed tomography scan was available in significantly fewer Hd-unstable patients ( 64 % vs 100 % ; P < .05 ) . Compared with Hd-stable patients , the Hd-unstable patients had a significantly higher intraoperative need for aortic occlusion balloon ( 40 % vs 6 % ; P < .05 ) , mean estimated blood loss ( 744 vs 363 mL ; P < .05 ) , incidence of developing abdominal compartment syndrome ( ACS ; 29 % vs 4 % ; P < .01 ) , and death ( 33 % vs 18 % ; P < .05 ) . ACS was a significant predictor of death ; death in all r-EVAR with ACS was significantly higher compared with all r-EVAR without ACS ( 10 of 17 [ 59 % ] vs 22 of 119 [ 18 % ] ; P < .01 ) . CONCLUSIONS EVAR for r-AAA is feasible in Hd-stable and Hd-unstable patients , with a comparable incidence of conversion to open surgical repair , nonfatal complications , and secondary interventions . Hd-stable patients have reduced mortality at 30 days , whereas Hd-unstable patients require intraoperative aortic occlusion balloon more frequently , and have an increased risk for developing ACS and death Background : Antibodies against Chlamydia pneumoniae are associated with an increased rate of expansion of small abdominal aortic aneurysms ( AAAs ) . Short-term follow-up trials have shown a transient reduction AAA growth rate , in macrolide treated compared with placebo . Therefore we analysed the influence of intermittent , long-term roxithromycin treatment on AAA expansion and referral for surgery . Methods : Eighty-four patients with small AAAs were r and omized to either an annual 4 weeks ’ treatment with roxithromycin or placebo , and followed prospect ively . Results : Intermittent , long-term Roxithromycin-treatment reduced mean annual growth rate by 36 % compared with placebo after adjustment for potential confounders . Long-term roxithromycin-treated patients had a 29 % lower risk of being referred for surgical evaluation , increasing to 57 % after adjusting for potential confounders . Conclusion : Annual 4 week treatment with 300 mg roxithromycin daily may reduce the progression of small AAAs , and later need for surgical repair . However , more robust studies are needed for confirmation BACKGROUND At present , several regions and countries are considering screening for abdominal aortic aneurysm ( AAA ) . However , The Chichester Aneurysms Screening Trial has reported poor long term benefit of screening for AAA . We therefore supplement previously published data with a preliminary analysis of the ten-year mortality from AAA , based upon population -based data until 2002 ( 7 years ) and incomplete hospital-based information on deaths until 2005 ( 10 years ) . METHODS AND MATERIAL In 1994 we started a r and omised screening trial of 12,639 64 - 73 year-old males ; 6,306 were controls , and 6,333 were invited to an abdominal ultrasound scan at their district hospital . Information on all deaths until 15.3.2005 was obtained from the Office of Civil Registration . Information on AAA related deaths was obtained from the national registry of Causes of Deaths from 1.4.1994 to 31.12.2001 , and supplemented with AAA deaths known to the Danish National Patient Registry until 15.3.2005 . Operations were obtained from the Danish National Vascular Registry from 1.4.1994 to 15.3.2005 . Death certificates and medical records were review ed by two independent assessors . The analyses were based on " intention to treat " from the date of r and omisation . RESULTS The attendance rate was 76.6 % and 191 ( 4.0 % ) had an AAA . The median observation time was 9.58 years . In the invited group 13 subjects were acutely operated on compared to 40 in the control group ( Risk ratio : 0.32 ( 95 % C.I. 0.17 - 0.60 , P<0.001 ) ) , and 14 died due to AAA compared to 51 in the control group ( Hazard ratio : 0.27 ( 95 % C.I. : 0.15 - 0.49 , P<0.001 ) . CONCLUSION Over ten years , screening reduced mortality from AAA by 73 % , and the frequency of emergency operations by 68 % During a recent 30-month period , we repaired 10 ruptured abdominal aortic aneurysms ( RAAA ) at our institution . To evaluate the survival , postoperative morbidity , and financial impact of treating RAAA , we compared these patients with  10 r and omly selected patients undergoing elective AAA ( EAAA ) . Both groups were comparable for age , gender , and incidence of diabetes , hypertension , coronary artery disease , chronic obstructive pulmonary disease ( COPD ) , and renal failure . Although we have noted a dramatic increase in survival for RAAA ( 90 % ) , the morbidity continues to be unacceptably high ( 60 % ) . Efforts should be made toward better detection of AAA prior to rupture as well as development of strategies to minimize or prevent these major complications . Potential average savings accrued from one patient undergoing EAAA repair rather than RAAA repair ( $ 93,139 . 21 ) can be used to perform screening abdominal ultrasound tests in patients at increased risk of having an AAA BACKGROUND The aim of the study was to analyse whether the selection and recruitment for hospital-based mass screening for abdominal aortic aneurysms ( AAA ) is acceptable for the population according to the criteria from the Council of Europe . METHODS A r and om sample of 4404 65 - 73-year-old males were invited to  hospital-based mass screening for AAA . As methods of secondary recruitment , they could change their time of appointment , and non-responders were reinvited once . RESULTS The attendance rate was 76 per cent ; 4.2 per cent had AAA . Men with cardiopulmonary and vascular diseases had higher attendance rate ( 80.5 per cent ) , and prevalence of AAA ( 9.1 per cent ) . Men with potentially mobility-disabling diseases also had a higher attendance rate ( 80.4 per cent ) . However , possible unfavourable social selection was noticed in the group of retired men with no information of former occupation . They had 68.5 per cent attendance , and 7.6 per cent AAA . If true , this selection decreases the number of potentially diagnosed AAA by only 2 per cent . Opportunity of revised appointment and reinvitation of non-responders increased the primary attendance of 65 per cent to 76 per cent . More AAA were found at secondary scans ( 6.3 per cent compared with 3.9 per cent ) . CONCLUSION The attendance rate fell markedly with age , but the recruitment was high even at the age of 73 , and travel distance and social class did not markedly influence uptake . A positive morbidity selection to screening for AAA was observed for cardiovascular or pulmonary diseases and potentially mobility-disabling diseases . Furthermore , higher prevalence of AAA was found for initial nonattenders . Thus , screening for AAA seems acceptable to the population , and extra efforts to increase the attendance are beneficial without increased costs per diagnosed AAA . Finally , if mass-screening proves to be cost-ineffective , selective screening of patients with hypertension or ischaemic heart disease might be beneficial In a 1997 report of a large  abdominal aortic aneurysm ( AAA ) screening study , we observed a negative association between  diabetes and AAA .  Although this was not previously described and negative associations between diseases are rare , the credibility of the finding was supported by consistent results in several previous studies and by the absence of an obvious artifactual explanation . Since that time , a variety of studies of AAA diagnosis , both by screening and prospect i ve clinical follow-up , have confirmed the finding . Other studies have reported slower aneurysm enlargement and fewer repairs for rupture in diabetics . The seeming protective effect of diabetes for AAA contrasts with its causal role in occlusive vascular disease and so provides a strong challenge to the traditional view of AAA as a manifestation of atherosclerosis . Research focused on a protective effect of diabetes has already increased our underst and ing of the etiology of AAA , and might eventually pave the way for new therapies to slow AAA progression The prevalence of abdominal aortic aneurysm ( AAA ) in a community‐based sample of men and women aged 65–79 years was correlated with known risk factors . In addition , the effect of high blood pressure and the use of antihypertensive medication on growth of AAAs were studied The aims of this study were to clarify the prevalence and the risk factors for unsuspected abdominal aortic aneurysm ( AAA ) in patients who underwent coronary artery bypass grafting for severe coronary artery disease and to identify the most at risk patients for AAA . Among 217 patients ( 189 men , mean age 64 + /- 11 years ) , asymptomatic AAAs , as prospect ively identified by echocardiography  , were found in 15 patients ( 6.9 % ) . All patients with AAAs were men and smokers or past smokers . Factors significantly associated by univariate analysis with asymptomatic AAA presence were smoking ( p = 0.003 ) , symptomatic peripheral artery disease ( p = 0.006 ) , significant carotid artery stenosis ( p = 0.007 ) , and larger femoral and popliteal diameters ( p = 0.008 and p = 0.0012 , respectively ) . The other classic demographic , clinical , and biologic features were equally distributed among patients . In conclusion , in patients who underwent coronary artery bypass grafting who were men and aged < 75 years with smoking histories , the prevalence of AAA was as high as 24 % when they had concomitant peripheral arterial disease and /or carotid artery stenosis ( vs 4.4 % in the absence of either condition , p = 0.007 ) , justifying consideration of AAA screening in this subgroup of in-hospital patients Importance An abdominal aortic aneurysm ( AAA ) is typically defined as aortic enlargement with a diameter of 3.0 cm or larger . The prevalence of AAA has declined over the past 2 decades among screened men 65 years or older in various European countries . The current prevalence of AAA in the United States is unclear because of the low uptake of screening . Most AAAs are asymptomatic until they rupture . Although the risk for rupture varies greatly by aneurysm size , the associated risk for death with rupture is as high as 81 % . Objective To up date its 2014 recommendation , the USPSTF commissioned a review of the evidence on the effectiveness of 1-time and repeated screening for AAA , the associated harms of screening , and the benefits and harms of available treatments for small AAAs ( 3.0 - 5.4 cm in diameter ) identified through screening . Population This recommendation applies to asymptomatic adults 50 years or older . However , the r and omized trial evidence focuses almost entirely on men aged 65 to 75 years . Evidence Assessment Based on a review of the evidence , the USPSTF concludes with moderate certainty that screening for AAA in men aged 65 to 75 years who have ever smoked is of moderate net benefit . The USPSTF concludes with moderate certainty that screening for AAA in men aged 65 to 75 years who have never smoked is of small net benefit . The USPSTF concludes that the evidence is insufficient to determine the net benefit of screening for AAA in women aged 65 to 75 years who have ever smoked or have a family history of AAA . The USPSTF concludes with moderate certainty that the harms of screening for AAA in women aged 65 to 75 years who have never smoked and have no family history of AAA outweigh the benefits . Recommendations The USPSTF recommends 1-time screening for AAA with ultrasonography in men aged 65 to 75 years who have ever smoked . ( B recommendation ) The USPSTF recommends that clinicians selectively offer screening for AAA with ultrasonography in men aged 65 to 75 years who have never smoked rather than routinely screening all men in this group . ( C recommendation ) The USPSTF recommends against routine screening for  AAA  with ultrasonography in women who have never smoked and have no family history of AAA . ( D recommendation ) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for AAA with ultrasonography in women aged 65 to 75 years who have ever smoked or have a family history of AAA . ( I statement ) OBJECTIVE To study the growth rate and factors influencing progression of small infrarenal abdominal aortic aneurysms ( AAA ) .  DESIGN Observational , longitudinal , prospect i ve study . PATIENTS AND METHODS We followed patients with AAA < 5 cm in diameter in two groups . Group I ( AAA 3 - 3.9 cm , n = 246 ) underwent annual ultrasound scans . Group II ( AAA 4 - 4.9 cm , n = 106 ) underwent 6-monthly CT scans . RESULTS We included 352 patients ( 333 men and 19 women ) followed for a mean of 55.2+/-37.4 months ( 6.3 - 199.8 ) . The mean growth rate was significantly greater in group II ( 4.72+/-5.93 vs. 2.07+/-3.23 mm/year ; p<0.0001 ) . Group II had a greater percentage of patients with rapid aneurysm expansion ( > 4 mm/year ) ( 36.8 vs. 13.8 % ; p<0.0001 ) . The classical cardiovascular risk factors did not influence the AAA growth rate in group I. Chronic limb ischemia was associated with slower expansion ( < or = 4 mm/year ) ( OR 0.47 ; CI 95 % 0.22 - 0.99 ; p = 0.045 ) . Diabetic patients in group II had a significantly smaller mean AAA growth rate than non-diabetics ( 1.69+/-3.51 vs. 5.22+/-6.11 mm/year ; p = 0.032 ) . CONCLUSIONS The expansion rate of small AAA increases with the AAA size . AAA with a diameter of 3 - 3.9 cm exp and slowly , and they are very unlikely to require surgical repair in 5 years . Many 4 - 4.9 cm AAA can be expected to reach a surgical size in the first 2 years of follow-up . Chronic limb ischemia and diabetes are associated with reduced aneurysm growth rates Aortic aneurysm is the 10th leading cause of death in older men [ 1 ] , but fundamental issues about the cause and epidemiology of this condition remain unresolved . A fourfold variation in the prevalence of abdominal aortic aneurysm ( AAA ) has been seen among participants in screening programs [ 2 ] , and the traditional view that AAA is a manifestation of atherosclerosis has been challenged by recent studies that suggest a role for specific genetic factors [ 3 ] . Most information on the epidemiology of AAA has come from screening studies [ 4 - 10 ] . However , the studies that have reported on potential risk factors have screened fewer than 5500 patients each , result ing in too few cases for multivariable analysis . Two nested casecontrol studies have reported multiple risk factor analyses for aortic aneurysms [ 11 , 12 ] , but these studies were also relatively small ( one contained 41 and one contained 165 aneurysms ) , did not attempt to identify all cases of AAA in their study population s , did not consider such important factors as family history of AAA , and disagreed about the significance of such factors as height and serum cholesterol levels . To identify factors that are independently associated with AAA and to determine the prevalence of previously unrecognized AAA in defined demographic and risk groups , we collected and analyzed self-reported information from a large cohort of veterans who participated in a multicenter ultrasonographic screening program . Methods Participants The Aneurysm Detection and Management ( ADAM ) study is an ongoing r and omized clinical trial comparing two strategies for the management of AAA ( immediate surgery and surgery reserved for aneurysms that enlarge to 5.5 cm , enlarge rapidly , or cause symptoms ) in patients 50 to 79 years of age with asymptomatic AAAs 4.0 to 5.4 cm in diameter [ 13 ] . Ultrasonography screening clinics were established at the 15 participating Department of Veterans Affairs medical centers to support recruitment into the trial . Active patients at these centers ( that is , patients treated during the current or previous fiscal year and those who had future appointments ) who met the age criteria for the study were invited by mail to attend the clinic . Throughout the screening period , the letters were mailed in batches according to patient social security number using the continuously up date d administrative patient data at each participating center . A second mailing that was done at some centers excluded persons who had previously been seen in the screening clinic . Active patients at the participating centers were also accepted for screening on a walk-in basis ; patients 50 to 79 years of age were included in the analysis because they were members of the target population and eventually would have been invited to participate . Inadvertent repeated screenings were identified by patient social security number , and results of second screenings were excluded . Patients who reported previously having been told that they had an AAA were also excluded . We include data from patients who were screened from the beginning of the program in October 1992 through March 1995 . The study was approved by the human rights committee at the Veterans Affairs Cooperative Studies Program coordinating center and by the institutional review boards at the 15 participating centers . Assessment of Associated Factors Before ultrasonographic examination , all patients completed a brief  question  naire that asked about demographic information and possible risk factors for AAA . Patients were asked whether they had ever been told by a physician that they had the condition in question ( for example , high blood pressure ) . The question naire was developed for the study , tested at the participating centers , and revised accordingly before the study began . The reliability of the data from the self-reported question naire was assessed by comparing this data with data collected in the subset of screened patients who had an AAA and who were later included in the clinical trial . These data were recorded by a study nurse after discussion with the patient and review of the patient 's medical records . Ascertainment of Abdominal Aortic Aneurysm The abdominal aorta was measured above and below the renal arteries using a 3.5-MHz real-time sector scanner . The ultrasonographers were instructed to 1 ) scan the aorta in the anteroposterior and lateral planes and 2 ) report the maximum external diameter at the widest point of any dilatation for the suprarenal and infrarenal segments . The ultrasonographers met twice during the study period to review techniques and compare measurement distributions . Patients found to have an AAA or another suspected abnormality were referred for evaluation , and discrepancies between the results of subsequent testing and the results of the initial screening were reported back to the study ultrasonographer . Screening appointments for patients whose examinations were inadequate because of insufficient fasting were rescheduled . An infrarenal aortic diameter of 4.0 cm or larger is generally agreed to constitute AAA , but no method for defining a smaller AAA has gained wide acceptance [ 14 ] . Most investigators have used unadjusted aortic diameter ( with such cutoff points as 3.0 cm , which is known to be associated with risk for rupture [ 15 ] ) but this practice may exaggerate the prevalence of AAA in larger people . To avoid this problem , use of a ratio of infrarenal aortic diameter to suprarenal aortic diameter of 1.5 or greater has been proposed [ 14 ] . However , this method labels some small aortas as having an AAA and fails to account for aneurysmal dilatation of the suprarenal aorta . The latter problem has , in turn , been addressed by a proposal to define AAA as an aortic diameter more than 1.5 times the diameter that would be expected on the basis of age , sex , body size , and other factors . However , values for the expected diameter have not been well defined [ 14 ] . Therefore , we considered several definitions of AAA , including an infrarenal aortic diameter of at least 3.0 cm , a diameter of at least 4.0 cm , and a ratio of infrarenal to suprarenal aortic diameter of 1.5 or greater . Statistical Analysis Analyses to determine the association between the items on the question naire and the presence of AAA were done using univariable and multivariable logistic regression . Because the purpose of the analysis was descriptive , the multivariable models included all variables that were considered in the question naire . Composite variables were formed from several questions that were used to identify coronary artery disease ; hypertension ; hypercholesterolemia ; and , in a separate analysis , any atherosclerosis . Responses of do n't know were treated as responses of no for specific diseases under the assumption that if a person had a disease , he or she would be aware of it . This assumption was not made for hypercholesterolemia or hypertension , which are often asymptomatic ; responses of do n't know for these conditions were considered to be missing . Because of the result ing large number of missing responses for hypercholesterolemia , an indicator variable was included for this item to prevent deletion of these patients from the logistic models ( as was otherwise done for missing responses ) [ 16 ] . Extreme values for height ( < 152 cm and > 198 cm ) , weight ( < 45 kg and > 182 kg ) , waist circumference ( < 56 cm and > 152 cm ) , and cholesterol levels ( < 2.59 mmol/L and > 12.93 mmol/L ) and smoking history incompatible with age were also excluded . To compare the many cases of smaller , borderline AAA with cases of larger , definite AAA , separate regression models were developed 1 ) for comparing patients who had AAAs of 3.0 to 3.9 cm with those who had infrarenal aortic diameters less than 3.0 cm and 2 ) for comparing those who had AAAs of 4.0 cm or larger with those who had infrarenal aortic diameters less than 3.0 cm . A third model was developed for comparing patients whose ratio of infrarenal to suprarenal aortic diameter was 1.5 or greater with those whose ratio was less than 1.5 . Comparison of question naire data with data collected for the clinical trial was made for categorical variables by using percent-pair agreement and the statistic and for continuous variables by using the mean difference ( question naire value minus clinical trial value ) and limits of agreement ( the range within which 95 % of the differences would be expected to occur , calculated as the mean difference 1.96 times the SD of the differences [ 17 ] ) . Results During the study period , 320 000 letters were mailed ; 5.3 % of these were returned because of an invalid address or death . Of the remaining letters , 30 % ( 91 000 letters ) were returned by persons willing to be screened . A total of 73 943 persons who were 50 to 79 years of age and did not have a history of AAA were screened ; 492 were excluded because the aorta could not be visualized . The remaining 73 451 patients constitute the study group , of whom 3.5 % were walk-ins . As Table 1 shows , the study group consisted primarily of men who had a history of smoking ( 97.2 % were male ; 75.5 % had a history of smoking ) . This closely reflects the population of U.S. veterans ( 96 % are male ; 74 % have a history of smoking [ 18 ] ) ; however , the study group also included 2078 women and 17 981 persons who had never smoked . Table 1 . Characteristics of 73 451 U.S. Veterans 50 to 79 Years of Age Screened for Abdominal Aortic Aneurysm * Abdominal aortic aneurysm , defined as an infrarenal aortic diameter of 3.0 cm or more , was detected in 3366 patients ( 4.6 % ) ; the infrarenal aortic diameter was at least 4.0 cm in 1031 patients ( 1.4 % ) . The frequencies of larger AAAs were as follows : Three hundred sixty-eight ( 0.50 % ) patients had an AAA of 5.0 cm or larger , 224 ( 0.30 % ) patients had an AAA of 5.5 cm or larger , 137 ( 0.19 % ) patients had an AAA of 6.0 cm or larger , 48 ( 0.07 % ) patients had an AAA of 7.0 cm or larger , and 22 ( 0.03 % ) patients had an AAA of 8.0 cm or larger . It can Abdominal aortic aneurysm ( AAA ) is an important cause of preventable death in older persons . Persistently high rupture mortality rates indicate that these deaths can be prevented only by early detection and treatment of AAA . In an effort to develop an effective and efficient program of AAA detection , we selectively screened a high-risk population . Men aged 60 to 75 years with hypertension and /or coronary artery disease were r and omly selected from a general medicine clinic and screened with physical examination and ultrasound . Eighteen previously unsuspected aneurysms , 3.6 to 5.9 cm in size ( mean , 4.4 cm ) , were detected in 201 patients , for a prevalence of 9 % ( 95 % confidence interval : 4.7 % to 13.3 % ) . The specificity and positive predictive value of ultrasound were each 100 % . Abdominal palpation detected only half of these aneurysms , but missed none in patients with an abdominal girth less than 100 cm ( n = 6 ) . This degree of sensitivity did not occur with " routine " examinations and requires that the examination be directed specifically toward AAA detection . We conclude that undiagnosed AAAs are common in this large subgroup of the clinic population , that ultrasound is an excellent screening test for AAAs , and that physical examination may be adequate for screening thin patients . We recommend that every two or three years persons over the age of 50 years undergo careful abdominal palpation aim ed at detecting AAAs , as part of the periodic health examination . We further recommend that obese older men at high risk for AAA have at least one-time screening with abdominal ultrasound , regardless of findings on physical examination
Due to the limited number of included trials , there is insufficient evidence to draw any conclusions about the effectiveness of cardiovascular prophylaxis in reducing mortality and cardiovascular events in people with AAA .
BACKGROUND Pharmacological prophylaxis has been proven to reduce the risk of cardiovascular events in individuals with atherosclerotic occlusive arterial disease .
However , the role of prophylaxis in individuals with abdominal aortic aneurysm ( AAA ) remains unclear .
Several studies have shown that despite successful repair , those people with AAA have a poorer rate of survival than healthy controls .
People with AAA have an increased prevalence of coronary heart disease and risk of cardiovascular events .
Despite this association , little is known about the effectiveness of pharmacological prophylaxis in reducing cardiovascular risk in people with AAA .
This is an up date of a Cochrane review first published in 2014 .
OBJECTIVES To determine the long-term effectiveness of antiplatelet , antihypertensive or lipid-lowering medication in reducing mortality and cardiovascular events in people with abdominal aortic aneurysm ( AAA ) .