Survival, Prevalence, Progression and Repair of Abdominal Aortic Aneurysms: Results from Three Randomised Controlled Screening Trials Over Three Decades

Figures & data

Table 1 Risk Factors and Comorbidities in Screened General Population Men Across Decades: Prevalence in All Attenders and Attenders with a Positive Test for Abdominal Aortic Aneurysm

	1990s (Viborg) N=4816	2000s (VIVA) N=18,748	2010s (DANCAVAS) N=10,471	P-value
Attenders (n)	4816	18,748	10,471
	Mean (SD)	Mean (SD)	Mean (SD)
Age (years)	67.3 (2.66)	69.0 (2.81)	69.0 (2.60)	<0.001
Height (cm)		176.0 (6.27)	177.0 (6.52)	<0.001
Body mass index (kg/m^2)	–	26.5 (3.57)	26.9 (3.80)	<0.001
Systolic blood pressure (mmHg)	–	158 (21.5)	149.8 (18.6)	<0.001
Diastolic blood pressure (mmHg)	–	85.6 (11.1)	82.2 (9.89)	<0.001
Ankle-brachial blood pressure index	–	1.04 (0.16)	1.11 (0.16)	<0.001
Max. aortic diameter (mm)	18.8 (5.16)	19.1 (5.26)	20.7 (5.05)	<0.001
	n (%)	n (%)	n (%)
Current smoking	*(45.0%)	3933 (21.1)	1582 (15.2)	<0.001
Use of low dose aspirin	–	6069 (33.4)	3756 (35.9)	<0.001
Use of statins	–	6420 (35.6)	3090 (34.8)	0.193
Use of antihypertensive therapy	–	7904 (42.5)	4788 (45.7)	0.001
Diabetes	95 (2.9)	2028 (10.9)	1230 (11.7)	<0.001
Previous acute myocardial infarction	351 (7.3)	974 (5.20)	694 (6.6)	<0.001
Previous ischemic heart disease	492 (10.2)	2171 (11.6)	1106 (10.6)	<0.001
Previous stroke	125 (2.6)	899 (4.8)	709 (6.8)	<0.001
Previous peripheral arterial disease	131 (2.7)	354 (1.9)	253 (2.4)	0.637
Positive screening test AAA (n)	184	618	443
	Mean (SD)	Mean (SD)	Mean (SD)
Age (years)	67.8 (2.80)	69.5 (2.79)	69.7 (2.61)	<0.001
Height (cm)	175.1 (9.61)	176.3 (6.04)	177.3 (6.75)	0.003
Body mass index (kg/m^2)	26.9 (3.75)	27.5 (3.76)	28.9 (4.32)	<0.001
Systolic blood pressure (mmHg)	158 (21.7)	155 (21.6)	149 (18.6)	<0.001
Diastolic blood pressure (mmHg)	93 (13.0)	87 (11.9)	83 (10.5)	<0.001
Ankle-brachial blood pressure index	0.97 (0.24)	0.95 (0.19)	0.98 (0.19)	0.030
Max. aortic diameter (mm)	38.0 (9.74)	40.6 (11.8)	38.8 (9.21)	<0.001
Aneurysmal growth rate (mm/year)	2.90 (2.56)	2.98 (2.57)	–	0.914
	n (%)	n (%)	n (%)
Current smoking	108 (62.1)	259 (41.4)	156 (35.4)	<0.001
Use of low dose aspirin	73 (41.2)	326 (52.6)	207 (46.7)	0.012
Use of statins	0 (0.0)	335 (54.1)	270 (60.9)	<0.001
Use of antihypertensives	60 (32.6)	339 (54.5)	268 (60.5)	<0.001
Diabetes	3 (2.3)	70 (11.3)	71 (16.0)	<0.001
Previous acute myocardial infarction	32 (17.4)	70 (11.3)	84 (19.0)	0.369
Previous ischemic heart disease	40 (9.8)	116 (18.8)	108 (24.3)	0.032
Previous stroke	8 (4.3)	55 (8.9)	57 (12.9)	0.003
Previous peripheral arterial disease	10 (5.4)	29 (4.7)	22 (5.0)	<0.001

Note: *Data from Osler et al.¹⁶

Abbreviation: AAA, abdominal aortic aneurysm.

Table 2 Association Between Smoking Status (%) and AAA

	Smoking	AAA	No AAA	All	Odds Ratio AAA (95% CI)
					Ever vs Never Smoker	Current vs Never Smoker	Ex vs Never Smoker
1990s*	Current	62	52	52	3.07 (1.45; 7.79)	3.37 (1.57; 8.63)	2.65 (1.20; 6.90)
	Ex	35	37	37
	Never	4	11	11
2000s	Current	41	20	21	4.78 (3.58; 6.51)	7.41 (5.45; 10.24)	3.70 (2.74; 5.09)
	Ex	50	50	50
	Never	8	30	29
2010s	Current	34	14	15	4.46 (3.27; 6.20)	7.96 (5.66; 11.36)	3.53 (2.56; 4.95)
	Ex	56	53	53
	Never	10	33	32

Note: *In the Viborg trial of the 1990s, smoking was only assessed for participants with a positive screening test. A matched gender and birth cohort from the 1994 Danish National Health and Morbidity Survey was therefore used to inform the missing distributions for the “No AAA” and “All” columns, respectively.²⁴

Abbreviation: AAA, abdominal aortic aneurysm.

Figure 1 Five-year cumulative aneurysmal repair for men with screen-detected abdominal aortic aneurysm in the 1990s versus the 2000s (Age adj. HR = 1.29, 95% C.I.: 0.95; 1.71, p=0.10).

Table 3 Age-Stratified Prevalence of Abdominal Aortic Aneurysms (n and %) and Overall Time Trends Across Decades (Odds Ratios with 95% Confidence Intervals)

	Age (Years)										Total	OR* (95% CI)
	65	66	67	68	69	70	71	72	73	74
1990s (Viborg)	71 (3.4)	11 (2.7)	13 (3.2)	14 (3.8)	14 (3.8)	19 (6.5)	19 (6.1)	10 (3.1)	13 (5.7)	–	184 (3.8)	1.00
2000s(VIVA)	55 (2.6)	52 (2.1)	70 (3.0)	69 (3.3)	73 (3.8)	54 (3.1)	67 (4.0)	74 (4.6)	41 (3.1)	67 (4.6)	618 (3.3)	0.76 (0.64–0.90)
2010s(DANCAVAS)	41 (2.9)	40 (3.3)	39 (3.2)	39 (3.1)	54 (4.3)	64 (5.5)	53 (5.1)	43 (4.4)	61 (7.5)	39 (6.0)	443 (4.2)	0.99 (0.82–1.19)

Note: *Age adjusted to account for the Viborg trial not including 74-year-old men odds ratios of abdominal aortic aneurysms between the three trials using the Viborg Study as reference.

Figure 2 Five-year mortality of men detected with abdominal aortic aneurysm in the 1990s versus the 2000s regarding overall mortality (Age-adjusted HR= 0.277, 95% C.I.: 0.215; 0.356, p<0.001).

Osler M, Prescott E, Gottschau A, et al. Trends in smoking prevalence in Danish adults, 1964-1994. The influence of gender, age, and education. Scand J Soc Med. 1998;26(4):293–298. doi:10.1177/140349489802600411019868755

 PubMedGoogle Scholar

Osler M, Holstein B, Avlund K, Damsgaard MT, Rasmussen NK. Socioeconomic position and smoking behaviour in Danish adults. Scand J Public Health. 2001;29(1):32–39. doi:10.1177/1403494801029001080111355714

 PubMed Web of Science ®Google Scholar