Surgical repair of aortic aneurysms and reduced incidence of dementia

Wang, Jen-Chun; Chien, Wu-Chien; Tzeng, Nian‐Sheng; Chung, Chi‐Hsiang; Lin, Chih‐Yuan

doi:10.1016/j.ijcard.2018.11.137

Cited by 13 publications

(6 citation statements)

References 33 publications

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“…There is a large and controversial amount of literature evaluating the association with coronary revascularization and risk of incident dementia, [37][38][39][40][41][42][43][44][45] but few studies have evaluated this association with noncardiac surgery. [15][16][17][18][19][20] Silber et al 19 demonstrated similar results to ours with a lower rate of incident dementia in individuals who underwent appendectomy compared with a matched nonsurgical control group (HR 0.89; 95% CI 0.86-0.92; p < 0.001). Their subgroup and sensitivity analyses supported the conclusion that appendectomy was not associated with an increased rate of dementia rather than a true protective effect given the magnitude of the rate was small, reflecting small unmeasured bias.…”

Section: Discussionsupporting

confidence: 83%

“…A recent study by our research group 14 demonstrated that the choice of anesthesia (regional vs. general) was not associated with an elevated rate of dementia in older patients undergoing elective noncardiac surgery, but few studies have examined the association between exposure to noncardiac surgery itself and the subsequent rate of developing dementia when compared with nonsurgical controls. [15][16][17][18][19][20] Thus, our objective was to examine the rate of incident dementia in patients undergoing elective noncardiac procedures as compared with nonsurgical controls to understand if there is an association between surgery and developing dementia.…”

Section: Introductionmentioning

confidence: 99%

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Association between surgery and rate of incident dementia in older adults: A population‐based retrospective cohort study

Reich,

Gill,

Eckenhoff

et al. 2024

J American Geriatrics Society

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BackgroundThe risk of incident dementia after surgery in older adults is unclear. The study objective was to examine the rate of incident dementia among older adults after elective surgery compared with a matched nonsurgical control group.MethodsWe conducted a population‐based, propensity‐matched retrospective cohort study using data from linked administrative databases in Ontario, Canada. All community‐dwelling individuals aged 66 years and older who underwent one of five major elective surgeries between April 1, 2007 and March 31, 2011 were included. Each surgical patient was matched 1:1 on surgical specialty of the surgeon at consultation, age, sex, fiscal year of entry, and propensity score with a patient who attended an outpatient visit with a surgeon of the same surgical specialty but did not undergo surgery. Patients were followed for up to 5 years after cohort entry for the occurrence of a new dementia diagnosis, defined from administrative data. Cause‐specific hazard models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for the association between surgery and the hazard of incident dementia. Subgroup and sensitivity analyses were performed.ResultsA total of 27,878 individuals (13,939 matched pairs) were included in the analysis. A total of 640 (4.6%) individuals in the surgical group and 965 (6.9%) individuals in the control group developed dementia over the 5‐year follow‐up period. Individuals who underwent surgery had a reduced rate of incident dementia compared with their matched nonsurgical controls (HR 0.88; 95% CI 0.80–0.97; p = 0.01). This association was persistent in most subgroups and after sensitivity analyses.ConclusionsElective surgery did not increase the rate of incident dementia when compared with matched nonsurgical controls. This could be an important consideration for patients and surgeons when elective surgery is considered.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Association between surgery and rate of incident dementia in older adults: A population‐based retrospective cohort study

Reich,

Gill,

Eckenhoff

et al. 2024

J American Geriatrics Society

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“…Both coronary and peripheral artery disease, which are representative atherosclerotic diseases, are known to be positively associated with the presence of AAA [14]. We have also demonstrated an association between intracranial aneurysm, vascular dementia, and AAs [15]. Although an association between AA and CVDs has been identified, the association between CVDs and the surgical removal of AAs remains unknown.…”

Section: Discussionmentioning

confidence: 67%

Association between surgical repair of aortic aneurysms and the diagnosis of subsequent cardiovascular diseases

Wang

Chien

Chung

et al. 2020

Journal of Cardiology

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Cardiovascular diseases (CVDs) and aortic aneurysms (AAs) have several clinical risk factors and molecular signaling pathways in common. Several atherosclerotic risk factors, including hypertension, smoking, and hyperlipidemia, are shared between CVDs and AAs [1,2]. The prevalence of abdominal aortic aneurysm (AAA) in patients with acute myocardial infarction (AMI) could be as high as 3% [3]. Risk factors for AAA include age !65 years, a history of smoking, and previous coronary artery bypass grafting in patients with AMI [3,4]. Currently, there are no approved medications to reduce the progression of AAs [5]. The usual threshold for elective repair of AAAs is an aortic diameter of 5.0 cm in women and 5.5 cm in men and a growth rate that exceeds 0.5 cm in diameter over a period of 6 months [2]. AAs are associated with systemic vascular inflammation and elevated levels of circulating inflammatory biomarkers [6,7]. Matrix metalloproteinases (MMPs) and inflammatory mediators are enriched in the vascular wall of AAs and may

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“…The mean annual incidence of new AAA diagnoses in Western populations is 0.4–0.67% 4 . Age is a risk factor for AAA, and there are similarities in epidemiological profiles between dementia and AAA including smoking, hypertension, obesity, and hyperlipidemia 2 , 4 , 5 .…”

Section: Introductionmentioning

confidence: 99%

The risk of dementia in adults with abdominal aortic aneurysm

Cho

Yoo

Kim

et al. 2022

Sci Rep

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Abdominal aortic aneurysm (AAA) and dementia have similar epidemiological profiles and common pathogenic mechanisms. However, there have been few studies on the link between these two diseases. For this study, information from 2009 to 2015 was extracted from the Korean National Health Insurance system database. A total of 15,251 participants with a new diagnosis of AAA was included. Propensity score matching by age and sex with patients in whom AAA was not diagnosed was used to select the control group of 45,753 participants. The primary endpoint of this study was newly diagnosed dementia (Alzheimer’s disease (AD), vascular dementia (VD), or other type of dementia). The incidence of dementia was 23.084 per 1000 person years in the AAA group, which was higher than that of the control group (15.438 per 1000 person years). When divided into AD and VD groups, the incidence of AD was higher than that of VD, but the HR of AAA for occurrence of dementia was higher in VD (1.382 vs. 1.784). Among the various risk factors, there was an interaction of age, hypertension, and history of cardiovascular disease with incidence of dementia (p < 0.05). In the presence of hypertension, the HR for occurrence of dementia was high according to presence or absence of AAA (1.474 vs 1.165). In addition, this study showed higher HR in the younger age group (age < 65) and in the group with no history of cardiovascular disease [1.659 vs. 1.403 (age), 1.521 vs. 1.255 (history of cardiovascular disease)]. AAA was associated with increased risk of dementia regardless of AD or VD, even after adjusting for several comorbidities. These findings indicate that follow-up with AAA patients is necessary for early detection of signs and symptoms of dementia.

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Surgical repair of aortic aneurysms and reduced incidence of dementia

Cited by 13 publications

References 33 publications

Association between surgery and rate of incident dementia in older adults: A population‐based retrospective cohort study

Association between surgery and rate of incident dementia in older adults: A population‐based retrospective cohort study

Association between surgical repair of aortic aneurysms and the diagnosis of subsequent cardiovascular diseases

The risk of dementia in adults with abdominal aortic aneurysm

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