Editor's Choice – Decrease in Mortality from Abdominal Aortic Aneurysms (2001 to 2015): Is it Decreasing Even Faster?

Abstract

The early 21st century has witnessed a global decrease in mortality from abdominal aortic aneurysms (AAA) which was associated with variations in the global prevalence of cardiovascular risk factors. This study investigates whether these trends continued into the second decade of the 21st century.Objective: The early twenty first century witnessed a decrease in mortality from abdominal aortic aneurysms (AAA), which was associated with variations in the prevalence of cardiovascular risk factors. This study investigated whether these trends continued into the second decade of the twenty first century. Methods: Information on AAA mortality (2001 À 2015) using International Classification of Diseases codes was extracted from the World Health Organization (WHO) mortality database. Data on risk factors were extracted from the Institute of Health Metrics and Evaluation and WHO InfoBase, and data on population from the World Development Indicators database. Regression analysis of temporal trends in cardiovascular risk factors was done independently for correlations with AAA mortality trends. Results: Seventeen countries across four continents met the inclusion criteria (Australasia, two; Europe, 11; North America, two; Asia, two). Male AAA mortality decreased in 13 countries (population weighted average: À2.84%), while female AAA mortality decreased in 11 countries (population weighted average: À1.64%). The decrease in AAA mortality was seen in both younger (< 65 years) and older (> 65 years) patients. The decrease in AAA mortality was more marked in the second decade of the twenty first century (2011 e 2015) compared with the first decade (2001 e 2005 and 2006 e 2010). Trends in AAA mortality positively correlated with smoking (males: p ¼ .03X, females: p ¼ .001) and hypertension (males: p ¼ .001, females: p ¼ .01X). Conversely, AAA mortality negatively correlated with obesity (males: p ¼ .001, females: p ¼ .001), while there was no significant correlation with diabetes. Conclusion: AAA mortality has continued to decline and seems to have declined at an even faster rate in the second decade of the twenty first century, albeit with heterogeneity among countries. These variations are multifactorial in origin but further efforts targeting smoking cessation and blood pressure control will probably contribute to continued reductions in AAA mortality.

AAA Revisited: A Comprehensive Review of Risk Factors, Management, and Hallmarks of Pathogenesis

“…The rise and fall of AAA-related mortality rates in developed countries correlate strongly with the changes in smoking prevalence [ 11 , 15 ]. Notably, AAA mortality in men is declining in many countries, particularly in the United States, the United Kingdom, and the Netherlands, while it seems to be on the rise among men and women in Hungary, Romania, and Japan [ 22 ].…”

Projection of global burden and risk factors for aortic aneurysm – timely warning for greater emphasis on managing blood pressure

“…However, our study suggests that AA-related mortality has increased in the recent three years and will continue increasing in the future. A study of trends in mortality from abdominal aortic aneurysms covering 17 countries showed an accelerating downward trend in mortality from abdominal aortic aneurysms as of 2015, but this study included fewer countries and mainly developed countries [ 20 ]. A Swedish population-based screening study observed a steady increase in the incidence of AAA among older men aged 65–99 years up to 2010, but they attributed the increase in the rate of diagnostic testing rather than a true increase in the incidence of AAA [ 4 ].…”

Female-Specific Considerations in Aortic Health and Disease

“…Although global mortality from AAAs is falling in both men and women, possibly related to decreased rates of smoking, women with AAAs still have lower survival compared with men with AAAs. 101 , 102 In a large 15-year national registry of 16,040 patients followed after elective endovascular aneurysm repair, 5-year survival was found to be significantly lower among White and Black women compared with White men (hazard ratio [HR], 1.2; 95% confidence interval [CI], 1.2-1.3 and HR, 1.4; 95% CI, 1.1-1.8, respectively). 103 Female sex has also been independently associated with significantly worse 30-day survival after elective repair after adjusting for repair type, age, aneurysm diameter, and comorbidities, but not aortic size index (odds ratio [OR],1.7; 95% CI, 1.1-2.6; P = 0.02).…”