Diabetes mellitus is not associated with major morbidity following open abdominal aortic aneurysm repair

Hughes, Kakra; Jackson, Jade D.; Prendergast, Tahira I.; Rose, David; Bolorunduro, Oluwaseyi; Obirieze, Augustine; Cornwell, Edward E.; Greene, Wendy R.; Obisesan, Thomas O.

doi:10.1016/j.jss.2013.04.025

Cited by 23 publications

(18 citation statements)

References 11 publications

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“…However, whether diabetes mellitus confers any survival disadvantage on patients after AAA repair is currently unclear. 31 Obesity is more common in economically developed countries; therefore, economic factors such as health expenditure could account for some of the differences observed in this study, and it is of interest to note that the United Kingdom spent 9.3% of its gross domestic product on health expenditure in 2011, whereas the United States, Romania, and Hungary spent 17.9%, 5.8%, and 7.7%, respectively.…”

Section: Discussionmentioning

confidence: 83%

Aneurysm Global Epidemiology Study

et al. 2014

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Background— Contemporary data from Western populations suggest steep declines in abdominal aortic aneurysm (AAA) mortality; however, international trends are unclear. This study aimed to investigate global AAA mortality trends and to analyze any association with common cardiovascular risk factors. Methods and Results— AAA mortality (1994–2010) using International Classification of Diseases codes were extracted from the World Health Organization mortality database and age standardized. The World Health Organization InfoBase and International Mortality and Smoking Statistics provided risk factor data. Nineteen World Health Organization member states were included (Europe, 14; Australasia, 2; North America, 2; Asia, 1). Regression analysis of temporal trends in cardiovascular risk factors (1946–2010) was done independently for correlations to AAA mortality trends. Global AAA mortality trends show substantial heterogeneity, with the United States and United Kingdom recording the greatest national decline, whereas internationally, male individuals and those <75 years of age demonstrated the greatest reductions. AAA mortality has increased in Hungary, Romania, Austria, and Denmark; therefore, the mortality decline is not universal. A positive linear relationship exists between global trends in systolic blood pressure ( P ≤0.03), cholesterol ( P ≤0.03), and smoking prevalence ( P ≤0.02) in males and females. Body mass index demonstrated a negative linear association with AAA mortality ( P ≤0.007), whereas fasting blood glucose showed no association. Conclusions— AAA mortality has not declined globally, and this study reveals that differences between nations can be explained by variations in traditional cardiovascular risk factors. Declines in smoking prevalence correlate most closely with declines in AAA mortality, and a novel obesity paradox has been identified that requires further investigation. Public health measures could therefore further reduce global AAA mortality, with greatest benefits in the younger age group.

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Section: Discussionmentioning

confidence: 83%

Aneurysm Global Epidemiology Study

et al. 2014

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“…A higher risk of complications in diabetics with AAA was also reported. 47,51,52,64 Owing to the variability in timing for assessment and reporting, long-term outcomes were not combined in a formal meta-analysis. Results of secondary analyses in diabetic patients and AAA Secondary meta-analyses were conducted to investigate the association of diabetes and AAA in overall incidence/prevalence studies and in sex subgroups.…”

Section: Results On Clinical Outcomes In Diabetic Patients With Aaamentioning

confidence: 99%

Diabetes and Abdominal Aortic Aneurysms

Rango

Farchioni

Fiorucci

et al. 2014

European Journal of Vascular and Endovascular Surgery

192

136

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Epidemiologic evidence suggests that patients with diabetes may have a lower incidence of abdominal aortic aneurysm (AAA); however, the link between diabetes and AAA development and expansion is unclear. The aim of this review is to analyze updated evidence to better understand the impact of diabetes on prevalence, incidence, clinical outcome, and expansion rate of AAA. A systematic review of literature published in the last 20 years using the PubMed and Cochrane databases was undertaken. Studies reporting appropriate data were identified and a meta-analysis performed using the generic inverse variance method. Sixty-four studies were identified. Methodological quality was "fair" in 16 and "good" in 44 studies according to a formal assessment checklist (Newcastle-Ottawa). In 17 large population prevalence studies there was a significant inverse association between diabetes and AAA: pooled odds ratio (OR) 0.80; 95% confidence intervals (CI) 0.70-0.90 (p = .0009). An inverse association was also confirmed by pooled analysis of data from smaller prevalence studies on selected populations (OR 0.59; 95% CI 0.35-0.99; p = .05), while no significant results were provided by case-control studies. A significant lower pooled incidence of new AAA in diabetics was found over six prospective studies: OR 0.54; 95% CI 0.31-0.91; p = .03. Diabetic patients showed increased operative (30-day/in-hospital) mortality after AAA repair: pooled OR 1.26; 95% CI 1.10-1.44; p = .0008. The increased operative risk was more evident in studies with 30-day assessment. In the long-term, diabetics showed lower survival rates at 2-5 years, while there was general evidence of lower growth rates of small AAA in patients with diabetes compared to non-diabetics. There is currently evidence to support an inverse relationship between diabetes and AAA development and enlargement, even though fair methodological quality or unclear risk of bias in many available studies decreases the strength of the finding. At the same time, operative and long-term survival is lower in diabetic patients, suggesting increased cardiovascular burden. The higher mortality in diabetics raises the question as to whether AAA repair should be individualized in selected diabetic populations at higher AAA rupture risk.

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“…Of these, 1,185 studies were excluded after the first screening based on abstracts or titles, leaving 81 articles for full-text review. After assessing the full-text of the 81 potentially relevant articles, 67 articles were excluded for the reasons listed in Figure 1, leaving 14 studies [22][23][24][25][26][27][28][29][30][31][32][33][34][35] included for the final analyses.…”

Section: Literature Searchmentioning

confidence: 99%