P1819Screening for abdominal aortic aneurysm in patients with cardiovascular disease: yield of screening and AAA related-mortality during follow-up

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A R De Boer ◽  
M L Bots ◽  
I Vaartjes ◽  
I Van Dis ◽  
J A Van Herwaarden ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Aortic Aneurysm ◽  
Population Based ◽  
Atherosclerotic Disease ◽  
Number Needed To Screen ◽  
Abdominal Aortic ◽  
Life Years ◽  
Artery Disease ◽  
Related Mortality

Abstract Background Abdominal aortic aneurysm (AAA) is a serious and life-threatening disease. Several countries introduced population-based screening programs targeting males ≥65 years old in an attempt to reduce AAA-related deaths. However, declining incidence rates of AAA and doubt about cost-effectiveness of population-based screening raises the question whether targeted screening in patients with already clinical manifest cardiovascular diseases could increase the yield of screening. Purpose The aim of this study was to assess prevalence of AAA in patients with clinical manifest cardiovascular disease and to evaluate AAA related mortality rates. Methods Data were obtained from 7446 patients (64361 patient-years of follow-up, median follow-up 8.3 years, interquartile ranges 4.6–12.3) with manifest atherosclerotic disease (62% coronary artery disease, 32% cerebrovascular disease, 18% peripheral artery disease) but without a history of AAA enrolled in the UCC-SMART study, an ongoing single-center, prospective cohort study. All patients underwent baseline examination including ultrasonography and presence of AAA was defined as local dilatation of the aorta with an anteroposterior diameter of 3 cm or larger on ultrasonography. Prevalence of AAA and number needed to screen to detect one aortic aneurysm were calculated stratified for sex and age. Finally, AAA related mortality rates were calculated for both the screen positive and negative group stratified for sex. Results Prevalence of newly detected AAA was 2.5% in male and 0.6% in female patients with manifest atherosclerotic disease translating to a number needed to screen of respectively 40 and 154 to detect one aortic aneurysm. In men the number needed to screen to detect one aneurysm decreases with age (134 in men between 50–54 years old; 36 in men between 60–64 years old; 22 in men between 70–75 years old), while in women this was less pronounced (124 in women between 50–54 years old; 81 in women between 60–64 years old; 83 in women between 70–75 years old). 80% of newly detected aneurysms in men was of the smallest diameter (3.0–3.9 cm), while 5% was of a diameter ≥5.5cm. All AAA related deaths (n=7) occurred in men. The incidence rate of AAA related mortality was 2.80 per 1000 patient-years in men with AAA after initial screening and 0.09 per 1000 patient-years without AAA after initial screening. Conclusion The yield of screening for AAA in male patients with manifest atherosclerotic disease is appreciable and number needed to screen to detect one aneurysm increases with age. If screening for AAA is considered, it should be performed in specific subgroups of older men with cardiovascular disease to improve yield of screening, taken into account other benefits and harms of AAA screening. Our findings, combined with a formal estimation of life years gained and disability adjusted life years gained attributed to screening and subsequent treatment is mandatory before taking definite steps. Acknowledgement/Funding University Medical Center Utrecht

Abstract 032: Associations between Middle-age Risk Factors and Future Risk of Abdominal Aortic Aneurysm: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Weihong Tang ◽  
Alvaro Alonso ◽  
Pamela L Lutsey ◽  
Frank A Lederle ◽  
Lu Yao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Middle Age ◽  
Disease Risk ◽  
Atherosclerotic Disease ◽  
Cross Sectional ◽  
Abdominal Aortic ◽  
Aric Study

Introduction: Abdominal aortic aneurysm (AAA) is an important manifestation of vascular disease in older age and rupture of an AAA is a life threatening condition. Traditional atherosclerotic disease risk factors, particularly male sex, smoking and hypertension, are known to contribute to the etiology of AAA. However, epidemiologic studies of AAA have often been cross-sectional, and few have employed a prospective cohort design, especially with long follow-up. The objective of this study was to prospectively assess the association between atherosclerotic disease risk factors and hospitalized AAA in 15,722 participants (68% whites) of the ARIC study, a large, community-based cohort. Methods: Risk factors were measured at baseline at 45-64 year of age. Clinical AAAs were ascertained through hospital discharge diagnoses or death certificates. Over 15 years of follow-up, a total of 265 AAAs (85.3% whites) were identified, including repair procedures, AAA rupture or dissection, and incidental detection. Multivariable Cox proportional hazard models were used to estimate the association of risk factors with the risk of future AAA. Results: Consistent with the literature from prospective studies, we identified age, male gender, white race, smoking, height, total and HDL cholesterols, triglycerides, white blood cell count, and hypertension as risk factors for AAA (Table). In addition, LDL-C, fibrinogen, and peripheral artery disease that were previously reported only in cross-sectional case-control studies were also strongly associated with AAA (Table). Body mass index, diabetes, and alcohol consumption were not associated with AAA occurrence. Conclusions: Several lifestyle and clinical variables measured in middle-age were strong risk factors for future AAA during a long follow-up.

scholarly journals Prise en charge de la maladie poly artérielle : résultats d’une étude transversale monocentrique à l’est Algérien

2021 ◽  
Vol 8 (1) ◽  
pp. 19-23
Author(s):  
Rachid Merghit ◽  
◽  
Ikhlas Gueriane ◽  
Mouloud Ait Athmane ◽  
Abdelhak Lakehal ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Abdominal Aortic Aneurysm ◽  
Coronary Artery ◽  
Aortic Aneurysm ◽  
Peripheral Artery Disease ◽  
Atherosclerotic Disease ◽  
University Hospital ◽  
Peripheral Artery ◽  
Abdominal Aortic ◽  
Artery Disease

Introduction. The rates of atherosclerotic disease as well as its multifocal aspects have been increasing significantly. It is important to know these associations to ensure comprehensive management of this category of patients. Aim. To estimate the frequency of the principal peripheral atherosclerotic associations in patients with coronary artery disease referred to cardiology in the University Hospital of Constantine. Methods. Our study is descriptive, cross-sectional, and mono-centric carried out in the unit of cardiovascular investigations of the Regional Military University Hospital of Constantine. The included patients had at least one significant coronary lesion ≥50 in a principal coronary artery. All our patients underwent an ultrasound evaluation (supra-aortic trunk echo-Doppler, Doppler Ultrasound of the aorta and lower limbs). Data were processed using SPSS Statistics V22. Results. The frequency of the association of Peripheral Artery Disease and Coronary Artery Disease was 34.7% representing the most frequent association. A hemodynamic carotid lesion (≥ 50%) and Abdominal Aortic Aneurysm were associated respectively with Coronary Artery Disease in 12% and 4.6% of patients in the current study. The triple association of coronary artery disease, Abdominal Aortic Aneurysm, and hemodynamic carotid disease was observed in 2.67%, whereas the triple association of Peripheral Artery Disease, coronary artery disease, and carotid stenosis≥50% was observed in 6.67%. The frequency of the association of coronary artery disease, Peripheral Artery Disease, and Abdominal Aortic Aneurysm was estimated at 3, 66%. The therapeutic strategy for multi-focal atherosclerotic disease is still discussed, but coronary artery disease dominates the prognosis. Conclusion. Carrying out a comprehensive assessment of patients with coronary artery disease helps significantly in establishing an adapted and pertinent management with an acceptable BenefitCost Ratio. Keywords: coronary artery disease; peripheral atheromatous disease; pan-vascular therapy.

scholarly journals B-type natriuretic peptide for prediction of incident clinically significant abdominal aortic aneurysm: A population-based prospective study

2018 ◽  
Vol 23 (1) ◽  
pp. 46-51 ◽  
Author(s):  
Stefan Acosta ◽  
Anders Gottsäter ◽  
Gunnar Engström ◽  
Olle Melander ◽  
Moncef Zarrouk ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Natriuretic Peptide ◽  
Population Based ◽  
Plasma Biomarker ◽  
Reactive Protein ◽  
Abdominal Aortic ◽  
Clinically Significant ◽  
Prospective Longitudinal

Pathogenesis of abdominal aortic aneurysm (AAA) is unclear. The aim of this study was to evaluate inflammatory and hemodynamic plasma biomarkers as predictors for AAA in the prospective longitudinal cohort of middle-aged individuals from the cardiovascular cohort of the Malmö Diet and Cancer Study ( n=5551; 1991–94). C-reactive protein, cystatin C, copeptin, N-terminal pro-B-type natriuretic peptide (N-BNP), midregional pro-atrial natriuretic peptide (MR-proANP) and conventional risk factors at baseline were measured in patients with incident AAA during follow-up and compared to individuals without a diagnosis of AAA. Subjects were followed until 31 December 2013. Multivariable analyses were expressed in terms of hazard ratios (HR) per 1 standard deviation increment of each respective log-transformed plasma biomarker in the Cox proportional hazard models. Mean follow-up time was 20.7 years. Cumulative incidence of AAA was 1.5% (men 2.9%, women 0.5%). Mean age of individuals with incident AAA was 59.7 years at study entry and AAA was diagnosed on average 14 years later. Adjusting for age, sex, smoking, body mass index, hypertension and diabetes mellitus, N-BNP (HR 1.29; 95% CI 1.03–1.62), but not MR-proANP (HR 1.20; 95% CI 0.95–1.50), was independently associated with incident AAA. In conclusion, the plasma biomarker N-BNP was associated with future development of AAA, which implies that this marker is a sensitive indicator of early subclinical cardiovascular disease.

scholarly journals Three-Year Results of the Nellix Endovascular Aneurysm Sealing System for Treatment of Abdominal Aortic Aneurysms in Frail Patients with Poor Anatomical Features

2020 ◽  
pp. 145749692091726
Author(s):  
A. Sonetto ◽  
S. Laukontaus ◽  
L. Vikatmaa ◽  
P. Aho ◽  
M. Venermo
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Open Surgery ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Technical Success ◽  
Abdominal Aortic ◽  
Instructions For Use ◽  
Related Mortality

Introduction: Endovascular aneurysm sealing represents an alternative to advanced technology devices for compromised patients with abdominal aortic aneurysms. We report our results of 15 fragile patients with very low-quality infrarenal necks treated with endovascular aneurysm sealing. Material and methods: All patients treated with Nellix device in our hospital between June 2015 and October 2016 were retrospectively reviewed. The primary endpoints are the following: overall survival and freedom from reintervention rates. The secondary endpoints are the following: technical success; 30-day mortality; abdominal aortic aneurysm–related mortality; and freedom from endoleak rate, complications, and surgical conversion rate. Results: Nellix was used in 15 patients, median age 75.5 years, of which 67% were unfit for open surgery. Mean aneurysm diameter was 60 mm. One-third (5/15) of the patients were inside the Nellix instructions for use. Technical success rate was 93.3%. No perioperative complications existed, and 30-day mortality was 0%. Median follow-up was 35 (interquartile range: 11–37) months. Survival rates at 1 and 3 years were 80% and 59.3%. Abdominal aortic aneurysm–related mortality occurred in 3 of 15 cases. Freedom from rupture rates at 1 and 3 years were 92.9% and 66%. Freedom from endoleak rates at 1 and 3 years were 92.9% and 74.5%. Freedom from reintervention rates at 1 and 3 years were 86.7% and 70.6%, with a dramatic drop to 37.1% at 4 years of follow-up. Three open surgery conversions were needed. There were no statistically significant differences in results between patients treated inside and outside instructions for use. Conclusion: The endovascular aneurysm sealing has shown encouraging short-term results, but its safety and effectiveness during time is questionable, because this system still carries high rates of reintervention, conversions for type IA endoleaks, and secondary aneurysm ruptures.

scholarly journals Prospective Comparison of Plasma Biomarker and Traditional Risk Factor Profiles for Incident Isolated Atherosclerotic Disease and Incident Isolated Abdominal Aortic Aneurysm

2022 ◽  
Vol 8 ◽  
Author(s):  
Stefan Acosta ◽  
Shahab Fatemi ◽  
Olle Melander ◽  
Gunnar Engström ◽  
Anders Gottsäter
Keyword(s):  
Risk Factor ◽  
Carotid Artery Disease ◽  
Traditional Risk Factor ◽  
Aortic Aneurysms ◽  
Atherosclerotic Disease ◽  
Prospective Comparison ◽  
Abdominal Aortic ◽  
Increased Risk ◽  
Artery Disease

Background: Traditional risk factors for atherosclerotic disease (AD) are well-known, of which some are relevant also for abdominal aortic aneurysms (AAA). The present study compares the importance of plasma biomarkers and traditional risk factor profiles for incident AD without concomitant AAA (isolated AD) and AAA without concomitant AD (isolated AAA) during long-term follow-up.Methods: In the Malmö Diet and Cancer Study—cardiovascular cohort, 5,381 participants were free from atrial fibrillation or flutter, AD (coronary artery disease, atherothrombotic ischemic stroke, carotid artery disease, or peripheral artery disease), and AAA underwent blood sampling under standardized fasting conditions between 1991 and 1994. Cox proportional hazards regression analysis was used to calculate hazard ratios (HR) with 95% CIs.Results: During a median follow-up of 23.1 years, 1,152 participants developed isolated AD, and 44 developed isolated AAA. Adjusted HR for lipoprotein-associated phospholipase A2 (mass) (HR 1.53, 95% CI 1.14–2.04 vs. HR 1.05, 95% CI.99–1.12) was higher for incident isolated AAA compared to incident isolated AD, respectively. Mid-regional pro-adrenomedullin (MR-proADM) was associated with incident isolated AD (HR 1.17, 95% CI 1.1–1.25) and incident isolated AAA (HR 1.47, 95% CI 1.15–1.88). MR-proADM was correlated (r = 0.32; p < 0.001) to body mass index (BMI), and BMI was associated with increased risk of incident isolated AAA (HR 1.43, 95% CI 1.02–2). No participant with diabetes mellitus (DM) at baseline developed isolated AAA (0/44), whereas DM was associated with an increased risk of isolated AD (HR 2.57, 95% CI 2.08–3.18). Adjusted HR for male sex (HR 4.8, 95% CI 2.42–9.48, vs. HR 1.76, 95% CI 1.56–1.98) and current smoking (HR 4.79, 95% CI 2.42–9.47 vs. HR 1.97, 95% CI 1.73–2.23) were higher in the incident isolated AAA group compared to the incident isolated AD group, respectively.Conclusions: The data supports the view that components of vascular inflammation and cardiovascular stress drives AAA development, whereas glycated cross-links in abdominal aortic wall tissue may have a plausible role in reducing AAA risk in individuals with DM.

scholarly journals Peripheral Artery Disease and Abdominal Aortic Aneurysm: The Forgotten Diseases in COVID-19 Pandemic. Results from an Observational Study on Real-World Management

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 672
Author(s):  
Francesco Natale ◽  
Raffaele Capasso ◽  
Alfonso Casalino ◽  
Clotilde Crescenzi ◽  
Paolo Sangiuolo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Peripheral Artery Disease ◽  
Absolute Risk ◽  
Lipid Lowering ◽  
Peripheral Artery ◽  
Abdominal Aortic ◽  
Artery Disease

Background and Objectives: It is well established that patients with peripheral artery disease (PAD) as well abdominal aortic aneurysm (AAA) have an increased cardiovascular (CV) mortality. Despite this higher risk, PAD and AAA patients are often suboptimality treated. This study assessed the CV profile of PAD and AAA patients, quantifying the survival benefits of target-based risk-factors modification even in light of the COVID-19 pandemic. Materials and Methods: PAD and AAA patients admitted for any reason to the Vascular Unit from January 2019 to February 2020 were retrospectively analyzed. Biochemical and CV profiles as well as ongoing medical therapies were recorded. Benefits of CV risk-factors control were estimated using the SMART-REACH model. A follow-up visit during the year 2020 was scheduled. Results: A total of 669 patients were included. Of these, 190 showed AAA and 479 PAD at any stage. Only 54% of PAD and 41% of AAA patients were on lipid-lowering drugs with non-optimal low-density lipoprotein (LDL) levels for most of them. A better control of all modifiable CV risk-factors based on the current guidelines would offer an absolute risk reduction of the mean 10-year CV risk by 9% in PAD and 14% in AAA. Unfortunately, the follow-up visit was lost because of COVID-19 limitations. Conclusions: Lipid profiles of PAD and AAA patients were far from guideline-based targets, and medical management was suboptimal. In our center, the COVID-19 pandemic impacted on the strict surveillance required in these very high-risk patients. The achievement of guideline-based therapeutic targets would definitively confer additional significant benefits in reducing the CV risk in these patients.

No relation between biomarkers at age 47–49 and aortic diameter after 14–19 years of follow-up – a population-based study

VASA ◽  
2017 ◽  
Vol 46 (4) ◽  
pp. 291-295 ◽  
Author(s):  
Soumia Taimour ◽  
Moncef Zarrouk ◽  
Jan Holst ◽  
Olle Melander ◽  
Gunar Engström ◽  
...  
Keyword(s):  
Population Based ◽  
Aortic Diameter ◽  
Aortic Dilatation ◽  
Population Based Study ◽  
Reactive Protein ◽  
Abdominal Aortic ◽  
Long Term Follow Up ◽  
Old Men

Abstract. Background: Biomarkers reflecting diverse pathophysiological pathways may play an important role in the pathogenesis of abdominal aortic aneurysm (aortic diameter ≥30 mm, AAA), levels of many biomarkers are elevated and correlated to aortic diameter among 65-year-old men undergoing ultrasound (US) screening for AAA. Probands and methods: To evaluate potential relationships between biomarkers and aortic dilatation after long-term follow-up, levels of C-reactive protein (CRP), proneurotensin (PNT), copeptin (CPT), lipoprotein-associated phospholipase 2 (Lp-PLA2), cystatin C (Cyst C), midregional proatrial natriuretic peptide (MR-proANP), and midregional proadrenomedullin (MR-proADM) were measured in 117 subjects (114 [97 %] men) aged 47–49 in a prospective population-based cohort study, and related to aortic diameter at US examination of the aorta after 14–19 years of follow-up. Results: Biomarker levels at baseline did not correlate with aortic diameter after 14–19 years of follow up (CRP [r = 0.153], PNT [r = 0.070], CPT [r = –.156], Lp-PLA2 [r = .024], Cyst C [r = –.015], MR-proANP [r = 0.014], MR-proADM [r = –.117]). Adjusting for age and smoking at baseline in a linear regression model did not reveal any significant correlations. Conclusions: Tested biomarker levels at age 47–49 were not associated with aortic diameter at ultrasound examination after 14–19 years of follow-up. If there are relationships between these biomarkers and aortic dilatation, they are not relevant until closer to AAA diagnosis.

Associations of coronary and peripheral artery disease with presence, expansion, and rupture of abdominal aortic aneurysm – a grin without a cat!

VASA ◽  
2017 ◽  
Vol 46 (3) ◽  
pp. 151-158 ◽  
Author(s):  
Hisato Takagi ◽  
Takuya Umemoto
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Peripheral Artery Disease ◽  
Literature Search ◽  
Systematic Literature Search ◽  
Peripheral Artery ◽  
Epidemiological Evidence ◽  
Abdominal Aortic ◽  
Artery Disease ◽  
Meta Analyses

Abstract. Both coronary and peripheral artery disease are representative atherosclerotic diseases, which are also known to be positively associated with presence of abdominal aortic aneurysm. It is still controversial, however, whether coronary and peripheral artery disease are positively associated with expansion and rupture as well as presence of abdominal aortic aneurysm. In the present article, we overviewed epidemiological evidence, i. e. meta-analyses, regarding the associations of coronary and peripheral artery disease with presence, expansion, and rupture of abdominal aortic aneurysm through a systematic literature search. Our exhaustive search identified seven meta-analyses, which suggest that both coronary and peripheral artery disease are positively associated with presence of abdominal aortic aneurysm, may be negatively associated with expansion of abdominal aortic aneurysm, and might be unassociated with rupture of abdominal aortic aneurysm.

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