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

Abstract

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.

Smoking, sex, risk factors and abdominal aortic aneurysm: is it all down to testosterone?

“…Jahangir et al 1 provided a fascinating analysis showing, among older people, a higher risk of abdominal aortic aneurysm (AAA) in those with normal body mass index (BMI), those who smoke and in men. Although AAA is relatively rare, ruptured AAA has a high mortality rate, so prevention, based on reversible risk factors, is important.…”

“…Smoking, sex and risk factors for AAA1 could be parsimoniously explained in terms of testosterone causing AAA in people as in mice, with smoking and male sex increasing the risk of AAA because they both result in higher testosterone, while obesity, particularly for men, could protect against AAA by lowering testosterone. More importantly, such mechanistic insight suggests an additional prevention mechanism for AAA, because a proven prevention and treatment agent for cardiovascular disease, statins, also reduces testosterone 7.…”

Oral Steroid Use and Abdominal Aortic Aneurysm Expansion ― Positive Association ―

“…1 Most AAA are asymptomatic, but once rupture occurs, the condition has a mortality rate of 65-85% and is ranked as the 16th most prominent cause of death in the USA in individuals aged ≥65 years. 2, 3 In Europe and the USA, the prevalence of the condition is 2% in men aged ≥65 years, with major risk factors for morbidity including male sex, age, history of smoking, and Caucasian race. 3, 4 The etiology in the majority of AAA is considered to be atherosclerosis, but a causal relationship with the typical risk factors for atherosclerosis, such as hypertension, dyslipidemia, and diabetes mellitus, remains unclear.…”

Long-term Survival Rates for Patients with Aortic Aneurysm

“…Subsequent changes in collagen due to remodeling will lead to a stiffer and less compliant vessel. 14 These findings differ from those for HT, 8,9 DM, 15 and BMI-defined obesity. 9 Dyslipidemia 16 and CKD may be involved in the pathophysiologic www.lipid.or.kr mechanism of development due to AA.…”

“…14 These findings differ from those for HT, 8,9 DM, 15 and BMI-defined obesity. 9 Dyslipidemia 16 and CKD may be involved in the pathophysiologic www.lipid.or.kr mechanism of development due to AA. In previous studies, calcium-channel blockers were an independent risk factor for the presence of an AAA and were associated with increased arterial aortic wall stiffness.…”