Low Prevalence of Abdominal Aortic Aneurysm Among 65-Year-Old Swedish Men Indicates a Change in the Epidemiology of the Disease

Abstract

Background-Screening elderly men with ultrasound is an established method to reduce mortality from ruptured abdominal aortic aneurysm (AAA; Evidence Level 1a). Such programs are being implemented and generally consist of a single scan at 65 years of age. We report the results from screening 65-year-old men for AAA in middle Sweden. Methods and Results-All 65-year-old men (nϭ26 256), identified through the National Population Registry, were invited to an ultrasound examination. An AAA was defined as a maximum infrarenal aortic diameter of Ն30 mm. In total, 22 187 (85%) accepted, and 373 AAAs were detected (1.7%; 95% confidence interval, 1.5 to 1.9). With 127 previously known AAAs (repaired/under surveillance) included, the total prevalence of the disease in the population was 2.2% (95% confidence interval, 2.0 to 2.4). Self-reported smoking (odds ratio, 3.4; PϽ0.001), coronary artery disease (odds ratio, 2.0; PϽ0.001), and hypertension (odds ratio, 1.6; Pϭ0.001) were independently associated with AAA in a multivariate logistic regression model. Thirteen percent of the entire population reported to be current smokers, one third of the frequency reported in the 1980s. The observed low prevalence of AAA was explained mainly by this change in smoking habits. Conclusions-On the basis of the observed reduced exposure to risk factors, lower-than-expected prevalence of AAA among 65-year-old men, unchanged AAA repair rate, and significantly improved longevity of the elderly population, the current generally agreed-on AAA screening model can be questioned. Important issues to address are the threshold diameter for follow-up, the possible need for rescreening at a higher age, and selective screening among smokers. (Circulation.

The UK EndoVascular Aneurysm Repair (EVAR) randomised controlled trials: long-term follow-up and cost-effectiveness analysis

“…These programmes have now reported a much lower prevalence of 1.9% in England and 1.7% in Sweden, respectively. 11,12 As well as the decline in incidence of clinically relevant aneurysms in men in England, Wales and Scotland, the age at which these aneurysms present has increased by 5-10 years. 13 Reports from other countries also show that aneurysm-related mortality is no longer increasing.…”

Smoking, sex, risk factors and abdominal aortic aneurysms: a prospective study of 18 782 persons aged above 65 years in the Southern Community Cohort Study

“…1 The overall prevalence is 2% in men above 65 years of age, 2 four times higher in men than women, 34 but with a worse prognosis in women than men. 56 While the annual incidence and prevalence rates of AAA continue to decline, 27–9 and mortality rates have dropped to just 2% in 2010, 10 death from all aortic aneurysms remains the 16th leading cause of death in the USA among those aged above 65 years. 10 The greatest mortality risk is among those previously undiagnosed who may present with ruptured AAA.…”

Asymptomatic Abdominal Aortic Aneurysms Show Histological Signs of Progression: A Quantitative Histochemical Analysis

“…Studies reported an AAA prevalence in the range of 4–7% for men aged 65 years or more [8,9] and increasing rates in incidence [10] and mortality [11]. Recent studies have shown a decrease of AAA prevalence to less than 2% in men aged ≥65 years [12] and there is evidence that the incidence and mortality from AAA is also declining [13]. These results may reflect the positive effects of reduced exposure to risk factors.…”