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.

The American Vascular Association Screening Program: Rationale, Method, Guidelines, and Progress

2005 ◽  
Vol 29 (2) ◽  
pp. 85-89 ◽  
Author(s):  
George S. Lavenson
Keyword(s):  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Screening Program ◽  
Carotid Artery Disease ◽  
Aortic Aneurysms ◽  
Peripheral Vascular ◽  
Early Management ◽  
Abdominal Aortic ◽  
Accredited Laboratories ◽  
Artery Disease

Introduction The Society of Vascular Surgery, in partnership with the Society for Vascular Ultrasound (SVU), established a National Vascular Screening Program thru the American Vascular Association (AVA). The program screens for the immediate causes of stroke, abdominal aortic aneurysms (AAA), and peripheral vascular disease. Detection of these conditions while the patient still is asymptomatic allows for early management and avoidance of the devastating events they can cause. Methods A quick carotid scan is used for detection of carotid artery disease, an EKG rhythm strip for atrial fibrillation, blood pressure determination for hypertension, a quick abdominal scan for AAA, and ankle/brachial indices for peripheral vascular disease. The SVU position on screening, recommending credentialed technologists and accredited laboratories, is used in the AVA screening program, and reporting only the presence or absence of disease has been recommended. Results The AVA program, and three other programs reported, screened 6,073 seniors. It is estimated that the carotid screenings alone prevented 30 strokes and saved $12,061,400,000 in stroke costs. Conclusion The AVA screening program, with quality ensured by the SVU guidelines, has the potential to prevent a major number of strokes and deaths. Recommendation is for extension of the screening program and for efforts to obtain Medicare funding for the screening.

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

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.

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.

scholarly journals Changes in insomnia as a risk factor for the incidence and persistence of anxiety and depression: a longitudinal community study

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Magnus Johansson ◽  
Markus Jansson-Fröjmark ◽  
Annika Norell-Clarke ◽  
Steven J. Linton
Keyword(s):  
Risk Factor ◽  
Depression Scale ◽  
Binary Logistic Regression ◽  
Anxiety And Depression ◽  
Hospital Anxiety ◽  
Dynamic Risk ◽  
Increased Risk ◽  
Longitudinal Association ◽  
Development Of Anxiety

Abstract Background The aim of this investigation was to examine the longitudinal association between change in insomnia status and the development of anxiety and depression in the general population. Methods A survey was mailed to 5000 randomly selected individuals (aged 18–70 years) in two Swedish counties. After 6 months, a follow-up survey was sent to those (n = 2333) who answered the first questionnaire. The follow-up survey was completed by 1887 individuals (80.9%). The survey consisted of questions indexing insomnia symptomatology, socio-demographic parameters, and the Hospital Anxiety and Depression Scale. Change in insomnia status was assessed by determining insomnia at the two time-points and then calculating a change index reflecting incidence (from non-insomnia to insomnia), remission (from insomnia to non-insomnia), or status quo (no change). Multivariate binary logistic regression analyses were used to examine the aim. Results Incident insomnia was significantly associated with an increased risk for the development of new cases of both anxiety (OR = 0.32, p < .05) and depression (OR = 0.43, p < .05) 6 months later. Incident insomnia emerged also as significantly associated with an elevated risk for the persistence of depression (OR = 0.30, p < .05), but not for anxiety. Conclusions This study extends previous research in that incidence in insomnia was shown to independently increase the risk for the development of anxiety and depression as well as for the maintenance of depression. The findings imply that insomnia may be viewed as a dynamic risk factor for anxiety and depression, which might have implications for preventative work.

scholarly journals Prognostic value of serum soluble ST2 in stable coronary artery disease: a prospective observational study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hack-Lyoung Kim ◽  
Jung Pyo Lee ◽  
Nathan Wong ◽  
Woo-Hyun Lim ◽  
Jae-Bin Seo ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Stable Coronary Artery Disease ◽  
Stable Condition ◽  
Baseline Serum ◽  
Soluble St2 ◽  
Increased Risk ◽  
Artery Disease ◽  
Stable Cad

AbstractThe role of ST2 in stable coronary artery disease (CAD) has not yet been well defined. This study was performed to investigate baseline serum soluble ST2 (sST2) level can predict clinical outcomes in patients with stable CAD. A total of 388 consecutive patients with suspected CAD (65 years and 63.7% male) in stable condition referred for elective invasive coronary angiography (ICA) was prospectively recruited. Major adverse cardiovascular event (MACE), including cardiac death, non-fatal myocardial infarction, coronary revascularization (90 days after ICA), and ischemic stroke during clinical follow-up was assessed. Most of the patients (88.0%) had significant CAD (stenosis ≥ 50%). During median follow-up of 834 days, there was 29 case of MACE (7.5%). The serum sST2 level was significantly higher in patients with MACE than those without (47.3 versus 30.6 ng/ml, P < 0.001). In multiple Cox regression model, higher sST2 level (≥ 26.8 ng/ml) was an independent predictor of MACE even after controlling potential confounders (hazard ratio, 13.7; 95% confidence interval 1.80–104.60; P = 0.011). The elevated level of baseline sST2 is associated with an increased risk of adverse clinical events in stable CAD patients. Studies with larger sample size are needed to confirm our findings.

Should the Presence or Extent of Coronary Artery Disease be Quantified in the CHA2DS2-VASc Score in Atrial Fibrillation? A Report from the Western Denmark Heart Registry

2018 ◽  
Vol 118 (12) ◽  
pp. 2162-2170 ◽  
Author(s):  
Kamilla Steensig ◽  
Kevin Olesen ◽  
Troels Thim ◽  
Jens Nielsen ◽  
Svend Jensen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Risk Factor ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Ischaemic Stroke ◽  
Independent Risk Factor ◽  
Oral Anticoagulants ◽  
Increased Risk ◽  
Artery Disease

Background Patients with atrial fibrillation (AF) have an increased risk of ischaemic stroke. The risk can be predicted by the CHA2DS2-VASc score, in which the vascular component refers to previous myocardial infarction, peripheral artery disease and aortic plaque, whereas coronary artery disease (CAD) is not included. Objectives This article explores whether CAD per se or extent provides independent prognostic information of future stroke among patients with AF. Materials and Methods Consecutive patients with AF and coronary angiography performed between 2004 and 2012 were included. The endpoint was a composite of ischaemic stroke, transient ischaemic attack and systemic embolism. The risk of ischaemic events was estimated according to the presence and extent of CAD. Incidence rate ratios (IRR) were calculated in reference to patients without CAD and adjusted for parameters included in the CHA2DS2-VASc score and treatment with anti-platelet agents and/or oral anticoagulants. Results Of 96,430 patients undergoing coronary angiography, 12,690 had AF. Among patients with AF, 7,533 (59.4%) had CAD. Mean follow-up was 3 years. While presence of CAD was an independent risk factor for the composite endpoint (adjusted IRR, 1.25; 1.06–1.47), extent of CAD defined as 1-, 2-, 3- or diffuse vessel disease did not add additional independent risk information. Conclusion Presence, but not extent, of CAD was an independent risk factor of the composite thromboembolic endpoint beyond the components already included in the CHA2DS2-VASc score. Consequently, we suggest that significant angiographically proven CAD should be included in the vascular disease criterion in the CHA2DS2-VASc score.

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