Atherosclerosis in Abdominal Aortic Aneurysms: A Causal Event or a Process Running in Parallel? The Tromsø Study

Johnsen, Stein Harald; Forsdahl, Signe Helene; Singh, Kuldeep; Jacobsen, Bjarne K.

doi:10.1161/atvbaha.110.203588

Cited by 105 publications

(84 citation statements)

References 31 publications

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“…AAA has traditionally been thought to be caused by atherosclerosis. Recently, this atherosclerosis theory has been challenged on the basis of epidemiologic, genetic and biochemical information, questioning whether atherosclerosis is a "bystander" condition or an active participant in the development and progression of AAA disease Johnsen et al, 2010;Lee et al, 1997;Reed et al, 1992;Trollope & Golledge, 2011). As seen in previously described studies on AAA prevalence in CAD patients, not all patients with atherosclerotic disease do present an AAA.…”

Section: Pathophysiologymentioning

confidence: 99%

“…However, recent case control studies did not find any evidence for more carotid atherosclerosis in AAA patients (Cheuk et al, 2007;Palazzzuoli et al, 2008). In an attempt to better elucidate this relationship, Johnsen et al reported significantly more carotid atherosclerosis in abdominal aortic aneurysm diameter  27 mm and in AAA (Johnsen et al, 2010). Among CAD patients, 5 studies appraised an association between AAA and PAD, while the association between AAA and CAS was analyzed in only 4 studies (table 5).…”

Section: Concomitant Vascular Disease To Abdominal Aortic Aneurysm Anmentioning

confidence: 99%

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Abdominal Aortic Aneurysm in Patients with Coronary Artery Disease: A Review Article

Elkalioubie¹,

Jude²,

Dupont³

2011

Diagnosis and Treatment of Abdominal and Thoracic Aortic Aneurysms Including the Ascending Aorta and the Aortic Arch

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Section: Pathophysiologymentioning

confidence: 99%

Section: Concomitant Vascular Disease To Abdominal Aortic Aneurysm Anmentioning

confidence: 99%

Abdominal Aortic Aneurysm in Patients with Coronary Artery Disease: A Review Article

Elkalioubie¹,

Jude²,

Dupont³

2011

Diagnosis and Treatment of Abdominal and Thoracic Aortic Aneurysms Including the Ascending Aorta and the Aortic Arch

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“…AAA and atherosclerotic CVD share common risk factors such as smoking and elevated blood pressure or cholesterol levels, and often co-exist. However, AAA and CVD may develop in parallel through different pathogenic mechanisms, with weakening of the aortic wall playing a key role in aortic dilation and AAA formation (7). Changes in the walls of aneurysmal aortas are characterised by up-regulation of proteolytic pathways, the loss of matrix, inflammation and, to a variable extent, atherosclerosis (22).…”

Section: Discussionmentioning

confidence: 99%

“…Aortic diameter is a marker of global cardiovascular risk even in the absence of an AAA. Increasing age and male gender are key risk factors for AAA (7). IGF1, IGF1 receptors and IGFBPs are expressed in vascular smooth muscle cells (VSMC) of human atherosclerotic plaques (8), and lower circulating levels of IGF1 have been associated with the incidence of cardiovascular events and stroke in previous studies (9,10).…”

Section: Introductionmentioning

confidence: 99%

Associations of IGF1 and its binding proteins with abdominal aortic aneurysm and aortic diameter in older men

Yeap

Chubb

McCaul

et al. 2012

European Journal of Endocrinology

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Objective: Abdominal aortic aneurysm (AAA) is most prevalent in older men. GH secretion declines with age resulting in reduced IGF1 levels. IGF1 and its binding proteins (IGFBPs) are expressed in vasculature, and lower IGF1 levels have been associated with cardiovascular risk factors and disease. However, the relationship of the IGF1 system with aortic dilation and AAA is unclear. We tested the hypothesis that circulating IGF1 and IGFBPs are associated with AAA and aortic diameter in older men. Design: A cross-sectional analysis involving 3981 community-dwelling men aged 70-89 years was performed. Methods: Abdominal aortic diameter was measured by ultrasound. Plasma total IGF1, IGFBP1 and IGFBP3 were measured by immunoassays. Results: After adjustment for age, body mass index, waist:hip ratio, smoking, hypertension, dyslipidemia, diabetes, coronary heart disease and serum creatinine, a higher IGF1 level was associated with AAA (odds ratio (OR)/1 S.D. increase 1.18, 95% confidence interval (CI) 1.05-1.33, PZ0.006), as was the ratio of IGF1/IGFBP3 (ORZ1.22, 95% CI 1.10-1.35, P!0.001). Highest IGF1 concentrations compared with lowest quintile were significantly associated with AAA (quintile (Q) 5 vs Q1: ORZ1.80, 95% CI 1.20-2.70, PZ0.004) as were IGF1/IGFBP3 ratios (Q5 vs Q1: ORZ2.52, 95% CI 1.59-4.02, P!0.001). IGF1 and IGFBP1 were independently associated with aortic diameter (bZ0.200, 95% CI 0.043-0.357, PZ0.012 and bZ0.274, 95% CI 0.098-0.449, PZ0.002 respectively). Conclusions: In older men, higher IGF1 and an increased ratio of IGF1/IGFBP3 are associated with AAA, while IGFBP1 is independently associated with increased aortic diameter. Components of the IGF1 system may contribute to, or be a marker for, aortic dilation in ageing men.

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“…As such, it was presumed that both entities were the result of extensive atherosclerosis [1]. This assumption was largely based on the fact that the two vascular diseases share a number of risk factors, such as smoking, hypertension, and older age [2e6].…”

Section: Introductionmentioning

confidence: 99%

Peripheral artery disease patients may benefit more from aggressive secondary prevention than aneurysm patients to improve survival

et al. 2016

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a b s t r a c tBackground and aims: Although it has become clear that aneurysmal and occlusive arterial disease represent two distinct etiologic entities, it is still unknown whether the two vascular pathologies are prognostically different. We aim to assess the long-term vital prognosis of patients with abdominal aortic aneurysmal disease (AAA) or peripheral artery disease (PAD), focusing on possible differences in survival, prognostic risk profiles and causes of death. Methods: Patients undergoing elective surgery for isolated AAA or PAD between 2003 and 2011 were retrospectively included. Differences in postoperative survival were determined using Kaplan-Meier and Cox regression analysis. Prognostic risk profiles were also established with Cox regression analysis. Results: 429 and 338 patients were included in the AAA and PAD groups, respectively. AAA patients were older (71.7 vs. 63.3 years, p < 0.001), yet overall survival following surgery did not differ (HR: 1.16, 95% CI: 0.87e1.54). Neither was type of vascular disease associated with postoperative cardiovascular nor cancer-related death. However, in comparison with age-and gender-matched general populations, cardiovascular mortality was higher in PAD than AAA patients (48.3% vs. 17.3%). Survival of AAA and PAD patients was negatively affected by age, history of cancer and renal insufficiency. Additional determinants in the PAD group were diabetes and ischemic heart disease. Conclusions: Long-term survival after surgery for PAD and AAA is similar. However, overall life expectancy is significantly worse among PAD patients. The contribution of cardiovascular disease towards mortality in PAD patients warrants more aggressive secondary prevention to reduce cardiovascular mortality and improve longevity.

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Atherosclerosis in Abdominal Aortic Aneurysms: A Causal Event or a Process Running in Parallel? The Tromsø Study

Abstract: The lack of a consistent dose-response relationship between atherosclerosis and abdominal aortic diameter suggests that atherosclerosis may not be a causal event in AAA but develops in parallel with or secondary to aneurismal dilatation.

Cited by 105 publications

References 31 publications

Abdominal Aortic Aneurysm in Patients with Coronary Artery Disease: A Review Article

Abdominal Aortic Aneurysm in Patients with Coronary Artery Disease: A Review Article

Associations of IGF1 and its binding proteins with abdominal aortic aneurysm and aortic diameter in older men

Peripheral artery disease patients may benefit more from aggressive secondary prevention than aneurysm patients to improve survival

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