Abdominal aortic aneurysm events in the women's health initiative: cohort study

Lederle, Frank A.; Larson, Joseph C.; Margolis, Karen L.; Allison, Matthew A.; Freiberg, Matthew S.; Cochrane, Barbara B.; Graettinger, William F.; Curb, J. David

doi:10.1136/bmj.a1724

Cited by 87 publications

(68 citation statements)

References 22 publications

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“…Previous studies, such as the Women‘s Health Initiative and the Rotterdam study, have demonstrated a strong association between AAA and smoking in women. 2324 Our study, however, is the first to describe a 2.5-fold higher risk of AAA among current female smokers compared to current male smokers (HR 9.17, 95% CI 4.95 to 17 and 3.4, 95% CI 1.96 to 5.9, respectively), though the interaction between smoking and gender was non-significant. This is much higher than the findings of the Rotterdam study, in which the OR for ever smoking was 3.8 (95% CI 1.57 to 9.20) in women compared to 3.3 (95% CI 3.04 to 3.67) in men.…”

Section: Discussionmentioning

confidence: 49%

Smoking, sex, risk factors and abdominal aortic aneurysms: a prospective study of 18 782 persons aged above 65 years in the Southern Community Cohort Study

Jahangir

Lipworth

Edwards

et al. 2015

J Epidemiol Community Health

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Background Abdominal aortic aneurysm (AAA) is a leading cause of death in the USA. We evaluated the incidence and predictors of AAA in a prospectively followed cohort. Methods We calculated age-adjusted AAA incidence rates (IR) among 18 782 participants aged ≥65 years in the Southern Community Cohort Study who received Medicare coverage from 1999–2012, and assessed predictors of AAA using multivariable Cox proportional hazards models, overall and stratified by sex, adjusting for demographic, lifestyle, socioeconomic, medical and other factors. HRs and 95% CIs were calculated for AAA in relation to factors ascertained at enrolment. Results Over a median follow-up of 4.94 years, 281 cases were identified. Annual IR was 153/100 000, 401, 354 and 174 among blacks, whites, men and women, respectively. AAA risk was lower among women (HR 0.48, 95% CI 0.36 to 0.65) and blacks (HR 0.51, 95% CI 0.37 to 0.69). Smoking was the strongest risk factor (former: HR 1.91, 95% CI 1.27 to 2.87; current: HR 5.55, 95% CI 3.67 to 8.40), and pronounced in women (former: HR 3.4, 95% CI 1.83 to 6.31; current: HR 9.17, 95% CI 4.95 to 17). A history of hypertension (HR 1.44, 95% CI 1.04 to 2.01) and myocardial infarction or coronary artery bypass surgery (HR 1.9, 95% CI 1.37 to 2.63) was negatively associated, whereas a body mass index ≥25 kg/m2 (HR 0.72; 95% CI 0.53 to 0.98) was protective. College education (HR 0.6, 95% CI 0.37 to 0.97) and black race (HR 0.44, 95% CI 0.28 to 0.67) were protective among men. Conclusions Smoking is a major risk factor for incident AAA, with a strong and similar association between men and women. Further studies are needed to evaluate benefits of ultrasound screening for AAA among women smokers.

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Section: Discussionmentioning

confidence: 49%

Smoking, sex, risk factors and abdominal aortic aneurysms: a prospective study of 18 782 persons aged above 65 years in the Southern Community Cohort Study

Jahangir

Lipworth

Edwards

et al. 2015

J Epidemiol Community Health

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“…It is still unclear, however, whether vascular hypertension is a cause, or symptom, of this arterial stiffening (Arribas et al 2006;McEniery et al 2007). In addition to heart failure, chronic hypertension is implicated as a major risk factor in the development of strokes (Nilsson 2005), renal failure (Lariviere and Lebel 2003) and aortic aneurysms (Lederle et al 2008). The fundamental role of elastic fibre components in maintaining arterial function is underlined by the severe clinical consequences of both fibrillin and tropoelastin mutations (Kielty et al 2002;Robinson and Booms 2001).…”

Section: Vascularmentioning

confidence: 99%

Tissue elasticity and the ageing elastic fibre

Sherratt

2009

AGE

266

189

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The ability of elastic tissues to deform under physiological forces and to subsequently release stored energy to drive passive recoil is vital to the function of many dynamic tissues. Within vertebrates, elastic fibres allow arteries and lungs to expand and contract, thus controlling variations in blood pressure and returning the pulmonary system to a resting state. Elastic fibres are composite structures composed of a cross-linked elastin core and an outer layer of fibrillin microfibrils. These two components perform distinct roles; elastin stores energy and drives passive recoil, whilst fibrillin microfibrils direct elastogenesis, mediate cell signalling, maintain tissue homeostasis via TGFβ sequestration and potentially act to reinforce the elastic fibre. In many tissues reduced elasticity, as a result of compromised elastic fibre function, becomes increasingly prevalent with age and contributes significantly to the burden of human morbidity and mortality. This review considers how the unique molecular structure, tissue distribution and longevity of elastic fibres pre-disposes these abundant extracellular matrix structures to the accumulation of damage in ageing dermal, pulmonary and vascular tissues. As compromised elasticity is a common feature of ageing dynamic tissues, the development of strategies to prevent, limit or reverse this loss of function will play a key role in reducing age-related morbidity and mortality.

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“…Clinical studies in women. In a prospective observational cohort study, hormone replacement therapy (HRT) of >5 years decreased the OR for AAA to 0.52 (0.34e0.78), 29 whereas another study showed no effect. 30 Moreover, in the ''Estrogen Plus Progestin Trial,'' there was no difference in the number of AAA cases between the women receiving estrogen plus progestin and the control group.…”

Section: Role Of Sex Hormones In Aaa Development and Growthmentioning

confidence: 99%

Sex Differences in Abdominal Aortic Aneurysm: The Role of Sex Hormones

Makrygiannis

Courtois

Drion

et al. 2014

Annals of Vascular Surgery

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Abdominal aortic aneurysm (AAA) is a complex multifactorial disease with genetic and environmental components. AAA is more common in men, whereas women have a greater risk of rupture and more frequently have concomitant thoracic aortic aneurysms. Moreover, women are diagnosed with AAA about 10 years later and seem to be protected by female sex hormones. In this MEDLINE-based review of literature, we examined human and animal in vivo and in vitro studies to further deepen our understanding of the sexual dimorphism of AAA. We focus on the role of sex hormones during the formation and growth of AAA. Endogenous estrogens and exogenous 17b-estradiol were found to exert favorable actions protecting from AAA in animal models, whereas exogenous hormone replacement therapy in humans had inconclusive results. Androgens, known to have detrimental effects in the vasculature, in sufficient levels maintain the integrity of the aortic wall through their anabolic actions and act differentially in men and women, whereas lower levels of testosterone have been associated with AAA in humans. In conclusion, sex differences remain an important area of AAA research, but further studies especially in humans are needed. Furthermore, differential molecular mechanisms of sex hormones constitute a potential therapeutic target for AAA.

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Abdominal aortic aneurysm events in the women's health initiative: cohort study

Cited by 87 publications

References 22 publications

Smoking, sex, risk factors and abdominal aortic aneurysms: a prospective study of 18 782 persons aged above 65 years in the Southern Community Cohort Study

Smoking, sex, risk factors and abdominal aortic aneurysms: a prospective study of 18 782 persons aged above 65 years in the Southern Community Cohort Study

Tissue elasticity and the ageing elastic fibre

Sex Differences in Abdominal Aortic Aneurysm: The Role of Sex Hormones

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