Elsevier

Journal of Vascular Surgery

Volume 52, Issue 3, September 2010, Pages 539-548
Journal of Vascular Surgery

Clinical research study
Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals

https://doi.org/10.1016/j.jvs.2010.05.090Get rights and content
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Background

Abdominal aortic aneurysm (AAA) disease is an insidious condition with an 85% chance of death after rupture. Ultrasound screening can reduce mortality, but its use is advocated only for a limited subset of the population at risk.

Methods

We used data from a retrospective cohort of 3.1 million patients who completed a medical and lifestyle questionnaire and were evaluated by ultrasound imaging for the presence of AAA by Life Line Screening in 2003 to 2008. Risk factors associated with AAA were identified using multivariable logistic regression analysis.

Results

We observed a positive association with increasing years of smoking and cigarettes smoked and a negative association with smoking cessation. Excess weight was associated with increased risk, whereas exercise and consumption of nuts, vegetables, and fruits were associated with reduced risk. Blacks, Hispanics, and Asians had lower risk of AAA than whites and Native Americans. Well-known risk factors were reaffirmed, including male gender, age, family history, and cardiovascular disease. A predictive scoring system was created that identifies aneurysms more efficiently than current criteria and includes women, nonsmokers, and individuals aged <65 years. Using this model on national statistics of risk factors prevalence, we estimated 1.1 million AAAs in the United States, of which 569,000 are among women, nonsmokers, and individuals aged <65 years.

Conclusions

Smoking cessation and a healthy lifestyle are associated with lower risk of AAA. We estimated that about half of the patients with AAA disease are not eligible for screening under current guidelines. We have created a high-yield screening algorithm that expands the target population for screening by including at-risk individuals not identified with existing screening criteria.

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This study was funded by a grant to the Society for Vascular Surgery from Life Line Screening, Independence, OH. The Society for Vascular Surgery provided a grant to the department of Health Evidence and Policy at Mount Sinai School of Medicine to be the data coordinating center for this project.

Competition of interest: Dr Manganaro is the Chief Medical Officer and a salaried employee of Life Line Screening, which is the source of the data used in this study, and reports no financial gain or any other material benefits from this publication.

The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a competition of interest.