Population based randomised controlled trial on impact of screening on mortality from abdominal aortic aneurysm

Norman, Paul; Jamrozik, Konrad; Lawrence-Brown, M.; Le, Max; Spencer, Carole A.; Tuohy, Raywin; Parsons, Richard; Dickinson, James A

doi:10.1136/bmj.38272.478438.55

Cited by 431 publications

(186 citation statements)

References 17 publications

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“…The study population was drawn from the Health In Men Study (27,28), which arose from a randomized population-based trial of ultrasound screening for abdominal aortic aneurysm in men ages 65-83 living in Perth, Western Australia. A total of 41,000 men were identified via the electoral roll (voting is compulsory in Australia) and randomized into invited and control groups of equal size.…”

Section: Methodsmentioning

confidence: 99%

Smoking, body weight, physical exercise, and risk of lower limb total joint replacement in a population‐based cohort of men

Mnatzaganian¹,

Ryan²,

Norman³

et al. 2011

Arthritis & Rheumatism

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Objective. To assess the associations of smoking, body weight, and physical activity with risk of undergoing total joint replacement (TJR) in a population-based cohort of men.Methods. A cohort study of 11,388 men that integrated clinical data with hospital morbidity data and mortality records was undertaken. The risk of undergoing TJR was modeled on baseline weight, height, comorbidity, socioeconomic status, years of smoking, and exercise in 3 separate age groups, using Cox proportional hazards regressions and competing risk regressions (CRRs).Results. Dose-response relationships between weight and risk of TJR and between smoking and risk of TJR were observed. Being overweight independently increased the risk of TJR, while smoking lowered the risk. The decreased risk among smokers was demonstrated in both Cox and CRR models and became apparent after 23 years of exposure. Men who were in the highest quartile (>48 years of smoking) were 42-51% less likely to undergo TJR than men who had never smoked. Tests for trend in the log hazard ratios (HRs) across both smoking and weight quantiles yielded significant P values. Vigorous exercise increased the hazard of TJR; however, the association reached statistical significance only in the 70-74-year-old age group (adjusted HR 1.64 [95% confidence interval 1.19-2.24]). Adjusting for Deyo-Charlson Index or Elixhauser's comorbidity measures did not eliminate these associations.Conclusion. Our findings indicate that being overweight and reporting vigorous physical activity increase the risk of TJR. This study is the first to demonstrate a strong inverse dose-response relationship between duration of smoking and risk of TJR. More research is needed to better understand the role of smoking in the pathogenesis of osteoarthritis.

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Section: Methodsmentioning

confidence: 99%

Smoking, body weight, physical exercise, and risk of lower limb total joint replacement in a population‐based cohort of men

Mnatzaganian¹,

Ryan²,

Norman³

et al. 2011

Arthritis & Rheumatism

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“…We also acknowledge that differential survival could have biased the results of the study, as men who were overweight or obese in mid-life might have died of competing diseases before reaching older age [21], so that surviving overweight and obese older men might be unusually healthy compared with their normal weight counterparts. We have previously reported that HIMS participants have lower mortality hazard than men who were invited but chose not to participate, and men in the general population who were not invited [22]. This suggests that HIMS participants are healthier than other men of their age living in the community, so that caution is required when attempting to generalize our findings.…”

Section: Limitations Of the Study Designmentioning

confidence: 72%

P2‐132: Body adiposity in later life and the incidence of dementia: The Health in Men study

Brian

Alfonso

Flicker

et al. 2011

Alzheimer's & Dementia

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Objective: To determine if adiposity in later life increases dementia hazard.Methods: Cohort study of 12,047 men aged 65-84 years living in Perth, Australia. Adiposity exposures were baseline body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR). We used the Western Australian Data Linkage System (WADLS) to establish the presence of new cases of dementia between 1996 and 2009 according to the International Classification of Diseases (ICD). Crude and adjusted hazard ratio (HR, 95% confidence interval, 95%CI) of dementia for each adiposity marker was calculated using Cox regression models. Other measured factors included age, marital status, education, alcohol use, smoking, diet, physical activity, and prevalent hypertension, diabetes, dyslipidaemia and cardiovascular disease.Results: Compared with men with BMI,25, participants with BMI between 25-30 had lower adjusted HR of dementia (HR = 0.82, 95% CI = 0.70-0.95). The HR of dementia for men with BMI$30 was comparable to men with BMI,25 (HR = 0.82, 95%CI = 0.67-1.01). Waist circumference showed no obvious association with dementia hazard. Men with WHR$0.9 had lower adjusted HR of dementia than men with WHR ,0.9 (HR = 0.82, 95%CI = 0.69-0.98). We found a ''J'' shape association between measures of obesity and the hazard of dementia, with the nadir of risk being in the overweight range of BMI and about 1 for WHR.Conclusions: Higher adiposity is not associated with incident dementia in this Australian cohort of older men. Overweight men and those with WHR$0.9 have lower hazard of dementia than men with normal weight and with WHR,0.9.

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“…36 Average baseline diameters and growth rates reported in the Western Australia screening study, 37 MASS,…”

Section: Growth Rates Of Small Abdominal Aortic Aneurysmsmentioning

confidence: 99%

“…Furthermore, it was the only cardiovascular outcome for which the association with higher pulse pressure was reversed (HR 0.91, 95% CI 0.86 to 0.98). 36 However, mean baseline BP levels reported in several large AAA surveillance studies 7,19,22,37 (Table 2) are all above what is currently considered as controlled (< 140/90 mmHg 45 ) and the AAA growth rates observed in these studies (see Table 1) may at least in part be related to these higher BPs.…”

mentioning

confidence: 96%

An evaluation of the effect of an angiotensin-converting enzyme inhibitor on the growth rate of small abdominal aortic aneurysms: a randomised placebo-controlled trial (AARDVARK)

Kiru

Bicknell

Falaschetti

et al. 2016

Health Technol Assess

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BACKGROUND: Although data are inconsistent, angiotensin-converting enzyme inhibitors (ACE-Is) have been associated with a reduced incidence of abdominal aortic aneurysm (AAA) rupture in analysis of administrative databases. OBJECTIVES: (1) To investigate whether or not the ACE-I perindopril (Coversyl arginine, Servier) reduces small AAA growth rate and (2) to evaluate blood pressure (BP)-independent effects of perindopril on small AAA growth and to compare the repeatability of measurement of internal and external aneurysm diameters. DESIGN: A three-arm, multicentre, single-blind, randomised placebo-controlled trial. SETTING: Fourteen hospitals in England. PARTICIPANTS: Men or women aged ≥ 55 years with an AAA of 3.0-5.4 cm in diameter by internal or external measurement according to ultrasonography and who met the trial eligibility criteria. INTERVENTIONS: Patients were randomised to receive 10 mg of perindopril arginine daily, 5 mg of the calcium channel blocker amlodipine daily or placebo daily. MAIN OUTCOME MEASURES: The primary outcome was AAA diameter growth using external measurements in the longitudinal plane, which in-trial studies suggested was the preferred measure. Secondary outcome measures included AAA rupture, AAA repair, modelling of the time taken for the AAA to reach the threshold for intervention (5.5 cm) or referral for surgery, tolerance of study medication (measured by compliance, adverse events and quality of life) and a comparison of the repeatability of measures of internal and external AAA diameter. Patients were followed up every 3-6 months over 2 years. RESULTS: In total, 227 patients were recruited and randomised into the three groups, which were generally well matched at baseline. Multilevel modelling was used to determine the maximum likelihood estimates for AAA diameter growth. No significant differences in the estimates of annual growth were apparent [1.68 (standard error 0.02) mm, 1.77 (0.02) mm and 1.81 (0.02) mm in the placebo, perindopril and amlodipine groups, respectively]. Similarly, no significant differences in the slopes of modelled growth over time were apparent between perindopril and placebo (p = 0.78) or between perindopril and amlodipine (p = 0.89). The results were essentially unaffected by adjustment for potential confounders. Compliance, measured by pill counts, was good throughout (> 80% at all visit time points). There were no significant in-trial safety concerns. Six patients withdrew because of adverse events attributed to the study medications (n = 2 perindopril, n = 4 amlodipine). No patients ruptured their AAA and 27 underwent elective surgery during the trial (n = 9 placebo, n = 10 perindopril, n = 8 amlodipine). CONCLUSIONS: We were unable to demonstrate a significant impact of perindopril compared with placebo or amlodipine on small AAA growth over a 2-year period. Furthermore, there were no differences in the times to reach a diameter of 5.5 cm or undergo surgery among the three groups. Perindopril and amlodipine were well tolerated by this population. ...

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Population based randomised controlled trial on impact of screening on mortality from abdominal aortic aneurysm

Cited by 431 publications

References 17 publications

Smoking, body weight, physical exercise, and risk of lower limb total joint replacement in a population‐based cohort of men

Smoking, body weight, physical exercise, and risk of lower limb total joint replacement in a population‐based cohort of men

P2‐132: Body adiposity in later life and the incidence of dementia: The Health in Men study

An evaluation of the effect of an angiotensin-converting enzyme inhibitor on the growth rate of small abdominal aortic aneurysms: a randomised placebo-controlled trial (AARDVARK)

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