scholarly journals Diagnosis of Gout is not Associated with Growth of Abdominal Aortic Aneurysms

2021 ◽  
Author(s):  
Shivshankar Thanigaimani ◽  
James Phie ◽  
Frank Quigley ◽  
Michael Bourke ◽  
Bernie Bourke ◽  
...  
Keyword(s):  
Aortic Aneurysms ◽  
Sensitivity Analyses ◽  
Medication Prescription ◽  
Abdominal Aortic ◽  
Increased Risk ◽  
Systemic Inflammatory Disease ◽  
Surveillance Programs ◽  
Independent Association ◽  
The Impact

Abstract IntroductionGout is a systemic inflammatory disease which has been associated with an increased risk of cardiovascular events but its association with abdominal aortic aneurysm (AAA) progression is unknown. The aim of this study was to investigate the association of gout with growth of small AAA. MethodsPatients with initial AAA diameter measuring 30-54mm were recruited from surveillance programs at four Australian centres. Maximum AAA diameter was measured with a standardised and reproducible protocol to monitor AAA growth. Presence of gout was defined by clinical diagnosis by clinician or prescription of medications used to treat gout. Linear mixed effects modelling was performed to examine the independent association of gout with AAA growth. ResultsA total of 637 participants, including 66 (10.3%) diagnosed with gout, received a median of 4 (Inter-quartile range (IQR): 3, 6) scans over a median follow-up of 1.8 (IQR: 1.0, 3.0) years. In unadjusted analyses, participants with diagnosis of gout had a slower mean annual AAA growth of -0.3 mm/year (95% CI: -0.7, 0.2; p=0.25) than those without gout. After adjusting for potential confounders including initial AAA diameter, body mass index, prior stroke and anti-hypertensive medication prescription, gout was not significantly associated with AAA growth (-0.3 mm/year; 95% CI: -0.7, 0.2; p=0.24). Sensitivity analyses investigating the impact of initial AAA diameter on the association of gout with AAA growth found no interaction. ConclusionThis study suggests diagnosis of gout is not associated with growth of small AAA.

Aneurysm Volumes After Endovascular Repair of Ruptured vs Intact Aortic Aneurysms: A Retrospective Observational Study

2020 ◽  
pp. 152660282096248
Author(s):  
José Oliveira-Pinto ◽  
Rita Soares-Ferreira ◽  
Nelson F. G. Oliveira ◽  
Elke Bouwens ◽  
Frederico M. Bastos Gonçalves ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Late Complications ◽  
Aortic Aneurysms ◽  
First Year ◽  
Volume Changes ◽  
Tertiary Referral ◽  
Abdominal Aortic ◽  
The Mean ◽  
The Impact

Purpose To compare changes in abdominal aortic aneurysm (AAA) sac volume between endovascular aneurysm repairs (EVAR) performed for ruptured (rEVAR) vs intact (iEVAR) AAAs and to determine the impact of early volume shrinkage on future complications. Materials and Methods A retrospective analysis was performed of all patients undergoing standard infrarenal EVAR from 2002 to 2016 at a tertiary referral institution. Only patients with degenerative AAAs and with 30-day and 1-year computed tomography angiography (CTA) imaging were included. Early sac shrinkage was defined as a volume sac reduction >10% between the first (<30-day) and the 1-year CTA. The primary endpoint was to compare AAA sac volume changes between patients undergoing rEVAR (n=51; mean age 71.0±8.5 years; 46 men) vs iEVAR (n=393; mean age 72.3±7.5 years; 350 men). Results are reported as the mean difference with the interquartile range (IQR Q1, Q3). The secondary endpoint was freedom from aneurysm-related complications after 1 year as determined by regression analysis; the results are presented as the hazard ratio (HR) and 95% confidence interval (CI). Results At baseline, the rEVAR group had larger aneurysms (p<0.001) and shorter (p<0.001) and more angulated (p=0.028) necks. Aneurysm sac volume decreased more in the rEVAR group during the first year [−26.3% (IQR −38.8%, −12.5%)] vs the iEVAR group [−11.9% (IQR −27.5%, 0); p<0.001]. However, after the first year, the change in sac volume was similar between the groups [−3.8% (IQR −32.9%, 31.9%) for rEVAR and −1.5% (IQR −20.9%, 13.6%) for iEVAR, p=0.74]. Endoleak occurrence during follow-up was similar between the groups. In the overall population, patients with early sac shrinkage had a lower incidence of complications after the 1-year examination (adjusted HR 0.59, 95% CI 0.39 to 0.89, p=0.01). Conclusion EVAR patients treated for rupture have more pronounced aneurysm sac shrinkage compared with iEVAR patients during the first year after EVAR. Patients presenting with early shrinkage are less likely to encounter late complications. These parameters may be considered when tailoring surveillance protocols.

scholarly journals No Effect of Hypercholesterolemia on Elastase-Induced Experimental Abdominal Aortic Aneurysm Progression

Biomolecules ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1434
Author(s):  
Toru Ikezoe ◽  
Takahiro Shoji ◽  
Jia Guo ◽  
Fanru Shen ◽  
Hong S. Lu ◽  
...  
Keyword(s):  
Smooth Muscle ◽  
Epidemiological Studies ◽  
Aortic Aneurysms ◽  
Lipid Lowering ◽  
Appreciable Effect ◽  
Male Mice ◽  
Elastin Degradation ◽  
Abdominal Aortic ◽  
Increased Risk ◽  
The Impact

Objective: Epidemiological studies link hyperlipidemia with increased risk for abdominal aortic aneurysms (AAAs). However, the influence of lipid-lowering drugs statins on prevalence and progression of clinical and experimental AAAs varies between reports, engendering controversy on the association of hyperlipidemia with AAA disease. This study investigated the impact of hypercholesterolemia on elastase-induced experimental AAAs in mice. Methods: Both spontaneous (targeted deletion of apolipoprotein E) and induced mouse hypercholesterolemia models were employed. In male wild type (WT) C57BL/6J mice, hypercholesterolemia was induced via intraperitoneal injection of an adeno-associated virus (AAV) encoding a gain-of-function proprotein convertase subtilisin/kexin type 9 mutation (PCSK9) followed by the administration of a high-fat diet (HFD) (PCSK9+HFD) for two weeks. As normocholesterolemic controls for PCSK9+HFD mice, WT mice were infected with PCSK9 AAV and fed normal chow, or injected with phosphate-buffered saline alone and fed HFD chow. AAAs were induced in all mice by intra-aortic infusion of porcine pancreatic elastase and assessed by ultrasonography and histopathology. Results: In spontaneous hyper- and normo-cholesterolemic male mice, the aortic diameter enlarged at a constant rate from day 3 through day 14 following elastase infusion. AAAs, defined as a more than 50% diameter increase over baseline measurements, formed in all mice. AAA progression was more pronounced in male mice, with or without spontaneous hyperlipidemia. The extent of elastin degradation and smooth muscle cell depletion were similar in spontaneous hyper- (score 3.5 for elastin and 4.0 for smooth muscle) and normo- (both scores 4.0) cholesterolemic male mice. Aortic mural macrophage accumulation was also equivalent between the two groups. No differences were observed in aortic accumulation of CD4+ or CD8+ T cells, B cells, or mural angiogenesis between male spontaneous hyper- and normocholesterolemic mice. Similarly, no influence of spontaneous hypercholesterolemia on characteristic aneurysmal histopathology was noted in female mice. In confirmatory experiments, induced hypercholesterolemia also exerted no appreciable effect on AAA progression and histopathologies. Conclusion: This study demonstrated no recognizable impact of hypercholesterolemia on elastase-induced experimental AAA progression in both spontaneous and induced hypercholesterolemia mouse models. These results add further uncertainty to the controversy surrounding the efficacy of statin therapy in clinical AAA disease.

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 &lt; 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 The impact of homocysteine on the risk of coronary artery diseases in individuals with diabetes: a Mendelian randomization study

2020 ◽  
Author(s):  
Tian Xu ◽  
Songzan Chen ◽  
Fangkun Yang ◽  
Yao Wang ◽  
Kaijie Zhang ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Confidence Interval ◽  
Mendelian Randomization ◽  
Sensitivity Analyses ◽  
European Ancestry ◽  
Causal Association ◽  
Increased Risk ◽  
The Impact ◽  
Cad Risk

Abstract Aims Observational studies have reported that homocysteine (Hcy) is associated with an increased risk of coronary artery disease (CAD) in individuals with diabetes, though controversy remains. The present study aimed to investigate the causal association between Hcy and CAD in individuals with diabetes. Methods A 2-sample Mendelian randomization (MR) study was designed to infer causality. Genetic summary data on the association of single nucleotide polymorphisms (SNPs) with Hcy were extracted from the hitherto largest genome-wide association study (GWAS) of up to 44,147 individuals of European ancestry. SNP-CAD data were obtained from another recently published GWAS which included 15,666 individuals with diabetes (3,968 CAD cases, 11,696 controls). The fixed-effects inverse variance-weighted method was employed to calculate the effect estimates. Other robust methods and leave-one-out analyses were used in the follow-up sensitivity analyses. Potential pleiotropy was assessed with the MR-Egger intercept test. Results The 2-sample MR analysis suggested no evidence of an association between genetically predicted plasma Hcy levels and CAD risk in individuals with diabetes (odds ratio = 1.14, 95% confidence interval: 0.82–1.58, p = 0.43) using 9 SNPs as instrumental variables. Similar results were observed in the follow-up sensitivity analyses. The MR-Egger intercept test indicated no evidence of directional pleiotropy (intercept = 0.03, 95% confidence interval: − 0.08–0.03, p = 0.35). Conclusion This 2-sample MR analysis found no evidence of a causal association between plasma Hcy levels and CAD risk in individuals with diabetes.

5α-reductase inhibitors and the risk of grade reclassification for men with long-term follow-up on active surveillance for prostate cancer.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 92-92
Author(s):  
Antonio Finelli ◽  
Narhari Timilshina ◽  
Maria Komisarenko ◽  
Robert Sowerby ◽  
Robert James Hamilton ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Cox Proportional Hazards ◽  
Sensitivity Analyses ◽  
Original Cohort ◽  
Reductase Inhibitors ◽  
Increased Risk ◽  
The Impact

92 Background: The role of 5α-reductase inhibitors (5-ARIs) in prostatic diseases remains controversial because of an FDA black box label. We have previously published on the impact of 5-ARIs in men managed with active surveillance (AS), demonstrating their protective effect against progression. However, the long-term safety of 5-ARIs in the setting of AS has never been described, thus we sought to assess this. Methods: This is a single-institution, prospectively maintained, retrospective cohort study comparing men taking a 5-ARI versus no 5-ARI while on AS for PCa. Pathologic progression was evaluated and defined as Gleason score > 6, maximum core involvement > 50%, or more than 3 cores positive on a follow-up prostate biopsy. Time dependent covariate analysis to account for time on AS but not on 5-ARI was conducted to diminish the likelihood of overestimating the benefit. To account for differences in prostate volume at baseline between 5-ARI and non-5-ARI groups sensitivity analyses were performed, restricting men in the non-5-ARI group to those with larger glands (volume > 40 ml). Kaplan-Meier analyses were conducted along with multivariable Cox proportional hazard regression modeling for predictors of pathologic progression. Results: The original cohort of 288 men on AS were analyzed. The median follow-up was 61.2 months (IQR: 29.8-95.24) with 124 men (43%) experiencing pathologic progression and 119 men (41.3%) abandoning AS. Men taking a 5-ARI experienced a lower rate of pathologic progression (24.3% vs 49.1%; p < 0.001) and were less likely to abandon AS (25.7% vs 46.3%; p = 0.002). On multivariable Cox proportional hazards analysis, lack of 5-ARI use was most strongly associated with pathologic progression (HR: 2.56; 95% confidence interval, 1.32-5.02). Sensitivity analyses done to account for gland size demonstrated that lack of 5-ARI use was still predictive of progression (HR: 2.76; CI, 1.45–5.25; p = 0.002). Importantly, 5-ARI use was not associated with increased risk of high-grade prostate cancer. Conclusions: 5-ARIs were associated with a significantly lower rate of pathologic progression and abandonment of AS in men with median follow-up of 5 years.

Abstract P256: Clinical Outcomes and Costs of a Pocket-Sized Ultrasound Device for Screening for Abdominal Aortic Aneurysm

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Manan Shah ◽  
Pankaj A Patel ◽  
Anna O DSouza ◽  
James K Min
Keyword(s):  
Incremental Cost ◽  
Aortic Rupture ◽  
Point Of Care ◽  
Aortic Aneurysms ◽  
Sensitivity Analyses ◽  
Ultrasound Screening ◽  
Medicare Beneficiaries ◽  
Abdominal Aortic ◽  
Study Population

BACKGROUND: While one-time ultrasound screening for abdominal aortic aneurysms (AAA) may reduce AAA-related adverse events--including death, aortic rupture, and emergent surgery--screening rates have averaged only 72% since the 2007 Medicare coverage policy was initiated. The introduction of a pocket-sized ultrasound (PSU) may enhance availability and convenience in the point-of-care setting, thereby enabling increased screening rates with reductions in AAA-related outcomes. OBJECTIVE: To develop a model to assess the clinical and economic impact of PSU versus standard ultrasound for AAA screening of eligible Medicare beneficiaries. METHODS: The model was developed from Medicare's perspective, including a study population of 65-74 year old males who had smoked ≥100 cigarettes in their lifetime. Our model assumed 100% of eligible males could be screened with the PSU, as compared to 72% actually screened with standard ultrasound. Model inputs were derived from major clinical trials, and included 4-year rates of mortality, aortic rupture, and elective and emergency surgeries. Model outputs of deaths reduced, ruptures avoided and costs (2009 USD) were calculated. One-way sensitivity analyses were performed to evaluate the robustness of model outcomes. RESULTS: A PSU strategy yielded a 16.8% and 25.6% reduction in rates of AAA-related mortality and rupture, respectively, as compared to the standard ultrasound strategy. During an 8-year follow-up period, the higher cost of elective surgeries by the PSU strategy was offset by lower rates and costs of emergency surgeries, as compared to the standard ultrasound strategy. The higher screening rate with the PSU strategy resulted in an incremental cost of $32 per screened eligible male over 8 years (annualized $4/year). Sensitivity analyses demonstrated reductions in deaths and aortic ruptures ranging from 7% to 28% and 1% to 52%, respectively, at an incremental cost/year ranging from -$2 to $52. CONCLUSION: Use of a PSU device to screen for AAA may reduce deaths, aortic ruptures, and surgery costs with a modest overall incremental cost of $4 per screened eligible male per year.

Abstract 128: Visit-to-visit Variability of Systolic BP and Renal Outcomes in the SPRINT Trial

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Jesse Goldman ◽  
Sandeep Aggarwal ◽  
Suzanne Boyle ◽  
Leslie Mcclure ◽  
Rebecca Seshasai ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Sensitivity Analyses ◽  
Renal Outcome ◽  
Chi Square ◽  
Renal Outcomes ◽  
Increased Risk ◽  
Post Hoc ◽  
The Impact

Increased visit-to-visit variability (VVV) in systolic blood pressure is a known predictor of adverse CV events & in diabetics, is associated with higher risk of incident albuminuria & chronic kidney disease. However, the impact of VVV in SBP on renal outcomes in the absence of diabetes is unknown. We investigated the association between VVV in SBP & adverse CVE & renal events among non-diabetic participants in SPRINT cohort. Methods: Primary exposure was quartile of within-person standard deviation of systolic blood pressure (SDBP). Primary outcomes 1) primary composite CV outcome from SPRINT study, 2) primary SPRINT renal outcome among those without CKD 3) incident albuminuria among those with & without CKD. We compared covariates by SDBP quartile, using ANOVA or chi-square tests. We fit incremental Cox hazards models to examine associations between SDBP & events. We performed sensitivity analyses for # visits in all models. Results: Among 9361 participants, 8589 (92%) met inclusion criteria & comprised the primary analytic sample. The mean SBP across all quartiles was similar (137 - 141 mmHg). There was no association between quartile of SDBP and the primary composite cardiovascular outcome. There was a significant association between quartile of SDBP and incident CKD among those without baseline CKD. Among 3350 participants without baseline CKD and 942 participants with CKD, higher VVV in SBP was independently associated with increased risk of incident albuminuria, regardless of baseline CKD status. This association was robust after adjustment for the number of visits. The interaction between SDBP and the primary intervention was not statistically significant in the no CKD (p=0.11) or CKD groups (p=0.93). Discussion: In this post-hoc analysis of SPRINT, we found that higher VVV in SBP is associated with greater risk of incident albuminuria among non-diabetic adults with and without baseline CKD. This association remained significant after adjustment for numerous potential confounders across follow-up. Our analysis demonstrates a significant association between VVV of SBP and incident albuminuria in patients with and without baseline CKD. This novel finding in an exclusively non-diabetic, hypertensive population deserves further investigation.

scholarly journals The Association between Migraine and Abdominal Aortic Aneurysms: A Nationwide Population-Based Cohort Study

2021 ◽  
Vol 18 (8) ◽  
pp. 4389
Author(s):  
Jou-Yu Lin ◽  
Che-Se Tung ◽  
Jen-Chun Wang ◽  
Wu-Chien Chien ◽  
Chi-Hsiang Chung ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort ◽  
Molecular Mechanisms ◽  
Cumulative Risk ◽  
Population Based ◽  
Aortic Aneurysms ◽  
Research Database ◽  
Abdominal Aortic ◽  
Increased Risk

Previous studies have indicated that patients with migraine have a higher prevalence of risk factors known to be associated with cardiovascular diseases. There are also shared epidemiology and molecular mechanisms between migraine and abdominal aortic aneurysm (AAA). We hypothesized that patients with migraine could have an increased risk of AAA. To test this hypothesis, we used the National Health Insurance Research Database (NHIRD) to evaluate whether associations exist between migraine and AAA. The data for this nationwide population-based retrospective cohort study were obtained from the NHIRD in Taiwan. The assessed study outcome was the cumulative incidence of AAA in patients with migraine during a 15-year follow-up period. Among the 1,936,512 patients from the NHIRD, 53,668 (2.77%) patients were identified as having been diagnosed with migraine. The patients with migraine had a significantly higher cumulative risk of 3.558 of developing an AAA 5 years after the index date compared with the patients without migraine. At the end of the 15-year follow-up period, a significantly higher incidence of AAA (0.98%) was observed in the patients with migraine than in those without migraine (0.24%). We revealed an association between the development of migraine and AAA.

Body mass index and risk of all-cause mortality in normotensive and hypertensive adults: The Rural Chinese Cohort Study

2021 ◽  
pp. 1-25
Author(s):  
Qionggui Zhou ◽  
Xuejiao Liu ◽  
Yang Zhao ◽  
Pei Qin ◽  
Yongcheng Ren ◽  
...  
Keyword(s):  
Cohort Study ◽  
Population Based ◽  
Normal Weight ◽  
Sensitivity Analyses ◽  
Hypertension Status ◽  
Moderation Effect ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Chinese Cohort ◽  
The Impact

Abstract Objective: The impact of baseline hypertension status on the BMI–mortality association is still unclear. We aimed to examine the moderation effect of hypertension on the BMI–mortality association using a rural Chinese cohort. Design: In this cohort study, we investigated the incident of mortality according to different BMI categories by hypertension status. Setting: Longitudinal population-based cohort Participants: 17,262 adults ≥18 years were recruited from July to August of 2013 and July to August of 2014 from a rural area in China. Results: During a median 6-year follow-up, we recorded 1109 deaths (610 with and 499 without hypertension). In adjusted models, as compared with BMI 22-24 kg/m2, with BMI ≤18, 18-20, 20-22, 24-26, 26-28, 28-30 and >30 kg/m2, the HRs (95% CI) for mortality in normotensive participants were 1.92 (1.23-3.00), 1.44 (1.01-2.05), 1.14 (0.82-1.58), 0.96 (0.70-1.31), 0.96 (0.65-1.43), 1.32 (0.81-2.14), and 1.32 (0.74-2.35) respectively, and in hypertensive participants were 1.85 (1.08-3.17), 1.67 (1.17-2.39), 1.29 (0.95-1.75), 1.20 (0.91-1.58), 1.10 (0.83-1.46), 1.10 (0.80-1.52), and 0.61 (0.40-0.94) respectively. The risk of mortality was lower in individuals with hypertension with overweight or obesity versus normal weight, especially in older hypertensives (≥60 years old). Sensitivity analyses gave consistent results for both normotensive and hypertensive participants. Conclusions: Low BMI was significantly associated with increased risk of all-cause mortality regardless of hypertension status in rural Chinese adults, but high BMI decreased the mortality risk among individuals with hypertension, especially in older hypertensives.

Sign in / Sign up

Export Citation Format

Share Document