AbstractThe mortality rate of ruptured abdominal aortic aneurysm (AAA) has been reported to be as high as 85%. Evidence suggests that ultrasound screening reduces overall and AAA-related mortality. The aim of this study was to identify and document risk factors for AAA from the largest Welsh cohort screened to date and compare the relative frequency of these risk factors in control subjects and AAA patients.
Patients were recruited to the AAA screening programme based in South East Wales through GP surgeries from 1993. Patient demographics and their AAA risk factors were collected for patients through a self-report questionnaire.Chi-squared tests and odds ratios (OR) were employed to determine the association between AAA and the presence of each of the established cardiovascular risk factors.
A total of 6,879 patients’ questionnaires were collected over a period of 23years (1993-2015). Two hundred and seventy-five (4.0% of the total sample)patients had ultrasonographic evidence of AAA, of which 45 (16%) were female and 230 (84%) were male. Patients with AAA were older than the control group(73 vs 69 years, P<0.0001). Smoking history (OR 1.69, 95% CI 1.29-2.21,P=0.0001) ischaemic heart disease (OR 2.13, 95% CI 1.66-2.74, P<0.0001)cerebrovascular disease (OR 2.25, 95% CI 1.62-3.14, P<0.0001), chronic lung disease (OR 1.56, 95% CI 1.21-2.03, P=0.0007), diabetes mellitus (OR 2.00,95% CI 1.43-2.71, P<0.0001), peripheral vascular disease (OR 1.78, 95% CI1.38-2.30, P<0.0001), surgical history of arteries/veins (OR 3.34, 95% CI 2.55-4.37, P<0.0001), family history of AAA (OR 3.70, 95% CI 2.57-5.33, P<0.0001)and taking regular medications (OR 2.00, 95% CI 1.29-3.06, P=0.0018) were more prevalent in AAA patients compared to controls. Hypertension was not found to be a risk factor for AAA (OR 1.02, 95% CI 0.79-1.32, P=0.89).#
In this largest Welsh cohort examined to date, the findings confirm that AAA disease is associated with established cardiovascular risk factors, consistent in part with the published literature. In contrast, no association was observed with hypertension and diabetes mellitus, rather than being a negative correlate, was in fact, positively associated with AAA. Collectively, these unique findings have practical implications with the potential to improve the clinical screening of patients with the ultimate aim of reducing mortality subsequent to AAA rupture.Furthermore, the genetic predisposition to AAA disease may require earlier identification of the “at risk” patients through application of a tailored screening programme.
|Date of Award||2017|
|Supervisor||Damian Bailey (Supervisor)|