Reduced lung function in patients with abdominal aortic aneurysm is associated with activation of inflammation and hemostasis, not smoking or cardiovascular disease

Fowkes, F. G. R.; Anandan, Chantelle; Lee, Dean A.; Smith, F. B.; Tzoulaki, Ioanna; Rumley, Ann; Powell, J.T.; Lowe, G. D. O.

doi:10.1016/j.jvs.2005.11.018

Cited by 56 publications

(72 citation statements)

References 33 publications

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“…Improved understanding of the pathophysiologic mechanisms of remote organ injury might suggest novel therapeutic strategies for decreasing perioperative morbidities [18,19]. In fact, Monsour et al showed that tourniquet-induced limb IR leads to mitochondrial dysfunction in thelung [20].…”

Section: Discussionmentioning

confidence: 99%

Inhibition of reactive oxygen species downregulates the MAPK pathway in rat spinal cord after limb ischemia reperfusion injury

Choi

Yeo

Park

et al. 2015

International Journal of Surgery

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Section: Discussionmentioning

confidence: 99%

Inhibition of reactive oxygen species downregulates the MAPK pathway in rat spinal cord after limb ischemia reperfusion injury

Choi

Yeo

Park

et al. 2015

International Journal of Surgery

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“…33,34 A host of other risk factors, such as poor lung function, 35 hypertension and high cholesterol levels, 36,37 have been suggested to increase the risk of aneurysmal development, although there are conflicting reports in the current literature. A positive family history, especially in male first-degree relatives, is also associated with increased risk of aneurysm.…”

Section: Other Risk Factorsmentioning

confidence: 99%

The UK EndoVascular Aneurysm Repair (EVAR) randomised controlled trials: long-term follow-up and cost-effectiveness analysis

Patel

Powell

Sweeting

et al. 2018

Health Technol Assess

101

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BackgroundShort-term survival benefits of endovascular aneurysm repair (EVAR) compared with open repair (OR) of intact abdominal aortic aneurysms have been shown in randomised trials, but this early survival benefit is soon lost. Survival benefit of EVAR was unclear at follow-up to 10 years.ObjectiveTo assess the long-term efficacy of EVAR against OR in patients deemed fit and suitable for both procedures (EVAR trial 1; EVAR-1); and against no intervention in patients unfit for OR (EVAR trial 2; EVAR-2). To appraise the long-term significance of type II endoleak and define criteria for intervention.DesignTwo national, multicentre randomised controlled trials: EVAR-1 and EVAR-2.SettingPatients were recruited from 37 hospitals in the UK between 1 September 1999 and 31 August 2004.ParticipantsMen and women aged ≥ 60 years with an aneurysm of ≥ 5.5 cm (as identified by computed tomography scanning), anatomically suitable and fit for OR were randomly assigned 1 : 1 to either EVAR (n = 626) or OR (n = 626) in EVAR-1 using computer-generated sequences at the trial hub. Patients considered unfit were randomly assigned to EVAR (n = 197) or no intervention (n = 207) in EVAR-2. There was no blinding.InterventionsEVAR, OR or no intervention.Main outcome measuresThe primary end points were total and aneurysm-related mortality until mid-2015 for both trials. Secondary outcomes for EVAR-1 were reinterventions, costs and cost-effectiveness.ResultsIn EVAR-1, over a mean of 12.7 years (standard deviation 1.5 years; maximum 15.8 years), we recorded 9.3 deaths per 100 person-years in the EVAR group and 8.9 deaths per 100 person-years in the OR group [adjusted hazard ratio (HR) 1.11, 95% confidence interval (CI) 0.97 to 1.27;p = 0.14]. At 0–6 months after randomisation, patients in the EVAR group had a lower mortality (adjusted HR 0.61, 95% CI 0.37 to 1.02 for total mortality; HR 0.47, 95% CI 0.23 to 0.93 for aneurysm-related mortality;p = 0.031), but beyond 8 years of follow-up patients in the OR group had a significantly lower mortality (adjusted HR 1.25, 95% CI 1.00 to 1.56,p = 0.048 for total mortality; HR 5.82, 95% CI 1.64 to 20.65,p = 0.0064 for aneurysm-related mortality). The increased aneurysm-related mortality in the EVAR group after 8 years was mainly attributable to secondary aneurysm sac rupture, with increased cancer mortality also observed in the EVAR group. Overall, aneurysm reintervention rates were higher in the EVAR group than in the OR group, 4.1 and 1.7 per 100 person-years, respectively (p < 0.001), with reinterventions occurring throughout follow-up. The mean difference in costs over 14 years was £3798 (95% CI £2338 to £5258). Economic modelling based on the outcomes of the EVAR-1 trial showed that the cost per quality-adjusted life-year gained over the patient’s lifetime exceeds conventional thresholds used in the UK. In EVAR-2, patients died at the same rate in both groups, but there was suggestion of lower aneurysm mortality in those who actually underwent EVAR. Type II endoleak itself is not associated with a higher rate of mortality.LimitationsDevices used were implanted between 1999 and 2004. Newer devices might have better results. Later follow-up imaging declined, particularly for OR patients. Methodology to capture reinterventions changed mainly to record linkage through the Hospital Episode Statistics administrative data set from 2009.ConclusionsEVAR has an early survival benefit but an inferior late survival benefit compared with OR, which needs to be addressed by lifelong surveillance of EVAR and reintervention if necessary. EVAR does not prolong life in patients unfit for OR. Type II endoleak alone is relatively benign.Future workTo find easier ways to monitor sac expansion to trigger timely reintervention.Trial registrationCurrent Controlled Trials ISRCTN55703451.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and the results will be published in full inHealth Technology Assessment; Vol. 22, No. 5. See the NIHR Journals Library website for further project information.

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“…Wedzicha et al [31] showed that during COPD exacerbations, plasma fibrinogen levels increased and they postulated that this could contribute to abnormal hemostasis and thrombosis, leading to adverse cardiovascular events. Fowkes et al [32] showed increases in circulating D-dimer (breakdown product of fibrin) in subjects with COPD. Hurst et al [33] looked at 36 biomarkers in subjects with COPD exacerbations and showed that plasma CRP concentration, in the presence of a major exacerbation symptom, may be useful in confirming a COPD exacerbation but did not predict exacerbation severity.…”

Section: Systemic Response and Copdmentioning

confidence: 99%

Chronic Obstructive Pulmonary Disease: A Chronic Systemic Inflammatory Disease

Eeden

Sin²

2007

Respiration

120

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Chronic obstructive pulmonary disease (COPD) is characterized by chronic inflammation in both the airways causing airway obstruction and the lung tissues causing emphysema. The disease is induced by inhalation of noxious gasses and particulate matter resulting in a chronic persistent inflammatory response in the lung, and the extent of the inflammatory reaction correlates with the severity of the disease. This chronic inflammatory response in the lung is also associated with a significant systemic inflammatory response with downstream adverse clinical health effects. The systemic response in COPD is associated with mortality, specifically cardiovascular mortality. This review describes the nature of the systemic inflammatory response in COPD and the clinical manifestations associated with the systemic response, with a focus on the potential mechanisms for these adverse health effects.

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Reduced lung function in patients with abdominal aortic aneurysm is associated with activation of inflammation and hemostasis, not smoking or cardiovascular disease

Cited by 56 publications

References 33 publications

Inhibition of reactive oxygen species downregulates the MAPK pathway in rat spinal cord after limb ischemia reperfusion injury

Inhibition of reactive oxygen species downregulates the MAPK pathway in rat spinal cord after limb ischemia reperfusion injury

The UK EndoVascular Aneurysm Repair (EVAR) randomised controlled trials: long-term follow-up and cost-effectiveness analysis

Chronic Obstructive Pulmonary Disease: A Chronic Systemic Inflammatory Disease

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