Physical activity and the risk of abdominal aortic aneurysm: a systematic review and meta-analysis of prospective studies

Aune, Dagfinn; Sen, Abhijit; Kobeissi, Elsa; Hamer, Mark; Norat, Teresa; Riboli, Elio

doi:10.1038/s41598-020-76306-9

Cited by 19 publications

(17 citation statements)

References 55 publications

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“…Last, the study did not investigate risk factors that have an association with AAA but that are often not routinely coded in primary care, such as physical activity. 36 The causality of physical activity, and other risk factors, in the prevention of AAA require further study.…”

Section: Discussionmentioning

confidence: 99%

Derivation and Validation of a 10-Year Risk Score for Symptomatic Abdominal Aortic Aneurysm: Cohort Study of Nearly 500 000 Individuals

Welsh

Jhund

et al. 2021

Circulation

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Background: Abdominal aortic aneurysm (AAA) can occur in patients who are ineligible for routine ultrasound screening. A simple AAA risk score was derived and compared to current guidelines used for ultrasound screening of AAA. Methods: UK Biobank participants without previous AAA were split into a derivation cohort (n=401,820, 54.6% women, mean age 56.4 years, 95.5% white race) and validation cohort (n=83,816). Incident AAA was defined as first hospital inpatient diagnosis of AAA, death from AAA, or an AAA-related surgical procedure. A multivariable Cox model was developed in the derivation cohort into an AAA risk score that did not require blood biomarkers. To illustrate the sensitivity and specificity of the risk score for AAA, a theoretical threshold to refer patients for ultrasound at 0.25% 10-year risk was modelled. Discrimination of the risk score was compared to a model of US Preventive Services Task Force (USPSTF) AAA screening guidelines. Results: In the derivation cohort there were 1,570 (0.40%) cases of AAA over a median 11.3 years of follow-up. Components of the AAA risk score were age (stratified by smoking status), weight (stratified by smoking status), antihypertensive and cholesterol lowering medication use, height, diastolic blood pressure, baseline cardiovascular disease, and diabetes. In the validation cohort, over ten years of follow-up, the C-index for the model of the USPSTF guidelines was 0.705 (95% CI 0.678, 0.733). The C-index of the risk score as a continuous variable was 0.856 (95%CI 0.837-0.878). In the validation cohort, the USPSTF model yielded sensitivity 63.9% and specificity 71.3%. At the 0.25% 10-year risk threshold, the risk score yielded sensitivity 82.1% and specificity 70.7%, while also improving the net reclassification index (NRI) compared to the USPSTF model +0.176 (95%CI 0.120, 0.232). A combined model, whereby risk scoring was combined with the USPSTF model, also improved prediction compared to USPSTF alone (NRI +0.101, 95%CI 0.055, 0.147). Conclusions: In an asymptomatic general population, a risk score based on patient age, height, weight and medical history may improve identification of asymptomatic patients at risk for clinical events from AAA. Further development and validation of risk scores to detect asymptomatic AAA is needed.

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Section: Discussionmentioning

confidence: 99%

Derivation and Validation of a 10-Year Risk Score for Symptomatic Abdominal Aortic Aneurysm: Cohort Study of Nearly 500 000 Individuals

Welsh

Jhund

et al. 2021

Circulation

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“…Regular exercise is generally safe for, and well tolerated by, patients with small AAAs and does not influence growth rates, but may reduce the risk of AAA development [ 133 , 134 , 135 ]. A well-balanced diet may reduce the risk of AAA, but studies analyzing diet quality in AAA patients are scarce [ 136 , 137 ].…”

Section: Risk Factors and Comorbiditiesmentioning

confidence: 99%

AAA Revisited: A Comprehensive Review of Risk Factors, Management, and Hallmarks of Pathogenesis

et al. 2022

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Despite declining incidence and mortality rates in many countries, the abdominal aortic aneurysm (AAA) continues to represent a life-threatening cardiovascular condition with an overall prevalence of about 2–3% in the industrialized world. While the risk of AAA development is considerably higher for men of advanced age with a history of smoking, screening programs serve to detect the often asymptomatic condition and prevent aortic rupture with an associated death rate of up to 80%. This review summarizes the current knowledge on identified risk factors, the multifactorial process of pathogenesis, as well as the latest advances in medical treatment and surgical repair to provide a perspective for AAA management.

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“…Physical activity could reduce the risk of aortic diseases because it has a beneficial effect on cardiovascular risk factors such as hypertension and arterial stiffness as well as an anti-inflammatory effect [17][18][19][20][21] . A previous meta-analysis of prospective studies suggested that higher levels of physical activity were associated with a reduced risk of aortic diseases; however, only five of nine studies showed no association, and three of five studies did not adjust for major confounders such as smoking, obesity, and hypertension 22) .…”

Section: Discussionmentioning

confidence: 91%

“…Our findings support the results of a metaanalysis of prospective studies on the association between physical activity and incidence of or mortality from abdominal aortic aneurysm. The summary relative risk for high versus low physical activity was 0.70 (95% CI: 0.56-0.87) 22) . However, in the abovementioned meta-analysis, no study on physical activity and mortality from aortic aneurysm showed a significant association between the two.…”

Section: Resultsmentioning

confidence: 99%

Association of Physical Activity with Aortic Disease in Japanese Men and Women: The Japan Collaborative Cohort Study

Tanimura

Teramoto

Tamakoshi

et al. 2023

JAT

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Aims: Evidence of the effects of physical activity on mortality from aortic diseases, especially in Asian populations, remains limited. This study aimed to examine these effects using data from a large long-term cohort study of Japanese men and women. Methods: Between 1988 and 1990, 32,083 men and 43,454 women in Japan, aged 40-79 years with no history of coronary heart disease, stroke, aortic diseases, or cancer, filled in questionnaires on time spent walking and participating in sports and were followed up until 2009. Multivariable hazard ratios (HRs) with 95% confidence intervals (CIs) of aortic disease mortality and its types (aortic aneurysm and dissection) according to the time spent walking and participating in sports were calculated after adjusting for potential confounding factors using the Cox proportional hazards model. Results: During a median follow-up of 19.1 years, a total of 173 deaths from aortic disease (91 cases of aortic dissection and 82 of aortic aneurysm) were documented. Sports participation time was inversely associated with the risk of death from aortic aneurysm: the multivariable HRs (95% CIs) were 0.68 (0.40-1.16) for ＜1 h/week, 0.50 (0.19-1.35) for 3-4 h/week, and 0.31 (0.10-0.93) for ≥ 5 h/week (p for trend=0.23) compared with 1-2 h/ week. The time spent walking was not associated with death from aortic aneurysm, dissection, and total aortic diseases.Conclusions: Greater time spent in sports participation was associated with a reduced risk of mortality from aortic aneurism in the Japanese population. Further studies are needed to investigate the relationship between physical activity and aortic dissection.

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Physical activity and the risk of abdominal aortic aneurysm: a systematic review and meta-analysis of prospective studies

Cited by 19 publications

References 55 publications

Derivation and Validation of a 10-Year Risk Score for Symptomatic Abdominal Aortic Aneurysm: Cohort Study of Nearly 500 000 Individuals

Derivation and Validation of a 10-Year Risk Score for Symptomatic Abdominal Aortic Aneurysm: Cohort Study of Nearly 500 000 Individuals

AAA Revisited: A Comprehensive Review of Risk Factors, Management, and Hallmarks of Pathogenesis

Association of Physical Activity with Aortic Disease in Japanese Men and Women: The Japan Collaborative Cohort Study

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