Prevalence and natural history of and risk factors for subaneurysmal aorta among 65-year-old men

Abstract

Background: The aims of this study were to determine the prevalence of screening-detected subaneurysmal aorta (SAA), i.e. an aortic diameter of 2.5–2.9 cm, its associated risk factors, and natural history among 65-year-old men.

Methods: A total of 14,620 men had their abdominal aortas screened with ultrasound and completed a health questionnaire containing information on smoking habits and medical history. They were categorized based on the aortic diameter: normal aorta (<2.5 cm; n = 14,129), SAA (2.5–2.9 cm; n = 258), and abdominal aortic aneurysm (AAA) (≥3.0 cm; n = 233). The SAA-group was rescanned after 5 years. Associated risk factors were analyzed.

Results: The SAA-prevalence was 1.9% (95% confidence interval 1.7%–2.1%), with 57.0% (50.7%–63.3%) expanding to ≥3.0 cm within 5 years. Frequency of smoking, coronary artery disease, hypertension, hyperlipidemia, and claudication were significantly higher in those with SAA and AAA compared to those with normal aortic diameter. Current smoking was the strongest risk factor for SAA (odds ratio [OR] 2.8; P < 0.001) and even stronger for AAA (OR 3.6; P < 0.001). Men with SAA expanding to AAA within 5 years presented pronounced similarities to AAA at baseline.

Conclusions: Men with SAA and AAA presented marked similarities in the risk factor profile. Smoking was the strongest risk factor with an incremental association with disease severity, and disease progression. This indicates that SAA and AAA may have the same pathophysiological origin and that SAA should be considered as an early stage of aneurysm formation. Further research on the cost-effectiveness and potential benefits of surveillance as well as smoking cessation and secondary cardiovascular prevention in this subgroup is warranted.

Keywords:

• Abdominal aortic aneurysm
• prevention and control
• screening
• smoking
• subaneurysmal aorta
• ultrasonography

Acknowledgements

The authors thank the collaborators Linda Lyttkens, RN, Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala; Ewa Pihl, RN, Department of Surgery, Falun County Hospital, Falun; Eva Ansgarius, BMA, Department of Physiology, Kullbergska Hospital, Katrineholm; Christina Sjöström, RN, Department of Surgery, Gävle County Hospital, Gävle; and Karina Docter, RN, Department of Surgery, Hudiksvall Hospital, Hudiksvall.

Disclosure statement

The authors declare that there is no conflict of interest.

Additional information

Notes on contributors

Knut Thorbjørnsen

Knut Thorbjørnsen, MD, Consultant General and Vascular Surgeon, Department of Surgery, Gävle County Hospital, Gävle, Sweden. PhD Student, Centre for Research and Development , Uppsala University/County Concil of Gävleborg, Gävle, Sweden. Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden.

Sverker Svensjö

Sverker Svensjö, MD, PhD, Consultant General and Vascular Surgeon, Head of Vascular Surgery, Department of Surgery, Falun County Hospital, Falun. Post-doc, Centre for Clinical Reseearch (CKF), Falun, Sweden. Department of Surgical Sciences, Vascular Surgery, Uppsala University, Sweden. Member of the Scientific Council of the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU).

Khatereh Djavani Gidlund

Khatereh Djavani Gidlund, MD, PhD, Consultant General and Vascular Surgeon, Department of Surgery, Gävle County Hospital, Gävle, Sweden. Post-doc, Centre for Research and Development, Uppsala University/County Concil of Gävleborg, Gävle, Sweden. Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden.

Nils-Peter Gilgen

Nils-Peter Gilgen, MD, Consultant General and Vascular Surgeon, Head of Vascular Surgery, Department of Surgery and Urology, Eskilstuna County Hospital, Eskilstuna, Sweden.

Anders Wanhainen

Anders Wanhainen, MD, PhD, Professor of Surgery and Research Leader, Department of Surgical Sciences, Vascular Surgery, Uppsala, Sweden. University, Clinical Chief of the Department of Vascular Surgery, Uppsala University Hospital, and Guest Professor of Surgery, Department of Surgical and Perioperative Sciences, Umeå University, Sweden.