Patients with abdominal aortic aneurysm: Are we missing the opportunity for cardiovascular risk reduction?

Lloyd, Geraint; Newton, James D.; Norwood, M. G. A.; Franks, S.C.; Bown, Matthew J.; Sayers, Robert D.

doi:10.1016/j.jvs.2004.06.039

Cited by 50 publications

(44 citation statements)

References 40 publications

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“…64 One of the earliest groups of drugs to be tested for any association with AAA growth or rupture were beta-blockers, but although laboratory models 65,66 provided encouraging evidence of a beneficial effect this has not translated convincingly into the general AAA population, 67 although some benefit has been seen in patients with Marfan syndrome. 68 Angiotensin converting enzyme (ACE) inhibitors are also thought to provide benefit to patients with AAA [69][70][71] but there is little evidence on their relationship with rupture and growth rates, 64,72 and there is some evidence to suggest that the use of ACE inhibitors may be harmful in these patients. 73,74 Non-steroidal anti-inflammatory drugs, and, in particular, cyclo-oxygenase-2 (COX-2) inhibitors, have also been suggested as an agent for reducing AAA growth rate 75 but this finding has not been reproduced consistently in other patient series.…”

Section: Medical Therapymentioning

confidence: 99%

The UK EndoVascular Aneurysm Repair (EVAR) trials: randomised trials of EVAR versus standard therapy.

Brown

Powell²,

Thompson³

et al. 2012

Health Technol Assess

207

170

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How to obtain copies of this and other HTA programme reports An electronic version of this title, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable DVD is also available (see below).Printed copies of HTA journal series issues cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our despatch agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per issue and for the rest of the world £3 per issue. How to order:-fax (with credit card details) -post (with credit card details or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you to either print out your order or download a blank order form. Contact details are as follows:Synergie UK (HTA Department) Digital House, The Loddon Centre Wade Road Basingstoke Hants RG24 8QW Email: orders@hta.ac.uk Tel: 0845 812 4000 -ask for 'HTA Payment Services' (out-of-hours answer-phone service) Fax: 0845 812 4001 -put 'HTA Order' on the fax header Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to University of Southampton and drawn on a bank with a UK address.Paying by credit card You can order using your credit card by phone, fax or post. SubscriptionsNHS libraries can subscribe free of charge. Public libraries can subscribe at a reduced cost of £100 for each volume (normally comprising 40-50 titles). The commercial subscription rate is £400 per volume (addresses within the UK) and £600 per volume (addresses outside the UK). Please see our website for details. Subscriptions can be purchased only for the current or forthcoming volume.How do I get a copy of HTA on DVD?Please use the form on the HTA website (www.hta.ac.uk/htacd/index.shtml). HTA on DVD is currently free of charge worldwide.The website also provides information about the HTA programme and lists the membership of the various committees. HTA NIHR Health Technology Assessment programmeThe Health Technology Assessment (HTA) programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care. The research findings from the HTA programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service' . The HTA programme is needs led in that it fills gaps in the evidence needed by the NHS. There are three routes to the start of projects...

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Section: Medical Therapymentioning

confidence: 99%

The UK EndoVascular Aneurysm Repair (EVAR) trials: randomised trials of EVAR versus standard therapy.

Brown

Powell²,

Thompson³

et al. 2012

Health Technol Assess

207

170

View full text Add to dashboard Cite

show abstract

“…Benefits include reduced acute vascular events and improved survival in patients with AAAs [42,43]. More recently, Hackam et al [44•] reported a large population-based, case-control study on the influence of ACE inhibition on the risk of aortic rupture.…”

Section: Ras and Human Aaasmentioning

confidence: 99%

The role of the renin-angiotensin system in aortic aneurysmal diseases

Lü¹,

Rateri²,

Cassis³

et al. 2008

Current Science Inc

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The renin-angiotensin system has been invoked in the development of both abdominal and thoracic aortic aneurysms. This has been demonstrated experimentally by the chronic subcutaneous infusion of angiotensin II, which consistently leads to development of abdominal aortic aneurysms (AAAs) in mice. Angiotensin II-induced AAAs have highly heterogenous cellular and extracellular matrix characteristics throughout the aorta that change markedly with infusion duration. The mechanistic basis for the reproducible location of AAA development has not been elucidated, but many insights have been provided, especially regarding receptor and inflammatory mechanisms. A recent clinical study provided limited evidence for extrapolating these results to mechanisms of human AAAs. Experimental evidence has also demonstrated that antagonism of angiotensin II type 1 (AT1) receptors prevents ascending aortic aneurysms in a murine model of Marfan's syndrome. A clinical study is currently ongoing to demonstrate the efficacy of AT1 receptor antagonism in humans.

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“…4 The mortality due to other cardiovascular causes in AAA is increasing because current screening programs lead to a larger number of patients undergoing surgical intervention, whereas the cardiovascular risk remains largely untreated. 5 Larger aneurysms are often characterized by the presence of intraluminal thrombus (ILT). 6 Although early reports suggested that ILT has a protective effect on the tensile stress of the aortic wall, 7 recent data show that ILT increases biochemical stress, leading to accelerated dilatation.…”

mentioning

confidence: 99%

Clot Architecture Is Altered in Abdominal Aortic Aneurysms and Correlates With Aneurysm Size

Scott

Prasad

Philippou

et al. 2011

ATVB

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Objective-Abdominal aortic aneurysm (AAA) is characterized by widening of the aorta. Once the aneurysm exceeds 5.5 cm, there is a 10% risk of death due to rupture. AAA is also associated with mortality due to other cardiovascular disease. Our aim was to investigate clot structure in AAA and its relationship to aneurysm size. Methods and Results-Plasma was obtained from 49 controls, 40 patients with small AAA, and 42 patients with large AAA. Clot formation was studied by turbidity, fibrin pore structure by permeation, and time to half lysis by turbidity with tissue plasminogen activator. Plasma clot pore size showed a stepwise reduction from controls to small to large AAA. Lag phase for plasma clot formation and time to half lysis were prolonged, with smaller AAA samples showing intermediate response. Clot structure was normal in clots made with fibrinogen purified from patients compared with controls, suggesting a role for other plasma factors. Endogenous thrombin potential and turbidity using tissue factor indicated that the effects were independent of changes in thrombin generation. Conclusion-Patients

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Patients with abdominal aortic aneurysm: Are we missing the opportunity for cardiovascular risk reduction?

Cited by 50 publications

References 40 publications

The UK EndoVascular Aneurysm Repair (EVAR) trials: randomised trials of EVAR versus standard therapy.

The UK EndoVascular Aneurysm Repair (EVAR) trials: randomised trials of EVAR versus standard therapy.

The role of the renin-angiotensin system in aortic aneurysmal diseases

Clot Architecture Is Altered in Abdominal Aortic Aneurysms and Correlates With Aneurysm Size

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