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

Huang, Xuewei; Wang, Zhouxiang; Shen, Zaiwen; Lei, Fang; Liu, Ye-Mao; Chen, Ze; Qin, Jianghui; Ji, Yan‐Xiao; Zhāng, Peng; Zhang, Xiaojing; Yang, Juan; Cai, Jingjing; She, Zhi‐Gang; Li, Hongliang

doi:10.1080/07853890.2022.2034932

Cited by 23 publications

(12 citation statements)

References 56 publications

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“…The study suggests that this trend will continue for the next decade and that high systolic blood pressure will replace smoking as the most important risk factor associated with aortic aneurysm death. A meta-analysis has shown that the risk of rupture in AAA patients with comorbid hypertension was 1.66 times higher than that in patients without comorbid hypertension [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Incidence and Outcomes of Abdominal Aortic Aneurysm Repair in New Zealand from 2001 to 2021

Gormley

Bernau

et al. 2023

JCM

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Purpose: The burden of abdominal aortic aneurysms (AAA) has changed in the last 20 years but is still considered to be a major cause of cardiovascular mortality. The introduction of endovascular aortic repair (EVAR) and improved peri-operative care has resulted in a steady improvement in both outcomes and long-term survival. The objective of this study was to identify the burden of AAA disease by analysing AAA-related hospitalisations and deaths. Methodology: All AAA-related hospitalisations in NZ from January 2001 to December 2021 were identified from the National Minimum Dataset, and mortality data were obtained from the NZ Mortality Collection dataset from January 2001 to December 2018. Data was analysed for patient characteristics including deprivation index, repair methods and 30-day outcomes. Results: From 2001 to 2021, 14,436 patients with an intact AAA were identified with a mean age of 75.1 years (SD 9.7 years), and 4100 (28%) were females. From 2001 to 2018, there were 5000 ruptured AAA with a mean age of 77.8 (SD 9.4), and 1676 (33%) were females. The rate of hospitalisations related to AAA has decreased from 43.7 per 100,000 in 2001 to 15.4 per 100,000 in 2018. There was a higher proportion of rupture AAA in patients living in more deprived areas. The use of EVAR for intact AAA repair has increased from 18.1% in 2001 to 64.3% in 2021. The proportion of octogenarians undergoing intact AAA repair has increased from 16.2% in 2001 to 28.4% in 2021. The 30-day mortality for intact AAA repair has declined from 5.8% in 2001 to 1.7% in 2021; however, it has remained unchanged for ruptured AAA repair at 31.6% across the same period. Conclusions: This study highlights that the incidence of AAA has declined in the last two decades. The mortality has improved for patients who had a planned repair. Understanding the contemporary burden of AAA is paramount to improve access to health, reduce variation in outcomes and promote surgical quality improvement.

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Section: Discussionmentioning

confidence: 99%

Incidence and Outcomes of Abdominal Aortic Aneurysm Repair in New Zealand from 2001 to 2021

Gormley

Bernau

et al. 2023

JCM

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“…Similar results were found in our study with quantitative analysis including EAPC and PAF. Based on GDB 2019 study, another research predicted a rebounding tendency in death of aortic, and high SBP would be the major risk factor ( 7 ). However, according to our result, a decreasing trend in ASRD, ASDALYR, and attributable risks was obtained, which means that the burden of aortic aneurysms would have a continuing decline globally.…”

Section: Discussionmentioning

confidence: 99%

“…They focused on the association between healthcare access and quality index (HAQ index) system with aortic aneurysm mortality and YLLs in different incomes and age groups ( 5 ). Associations between estimated average percentage change (EAPC) and burden of aortic aneurysm, human development index (HDI) were found respectively ( 6 ), and aortic aneurysm-related death and attributable risks in the next decade were projected ( 7 ). However, they did extensive efforts on the health epidemiology of aortic aneurysms, and much remains to be performed.…”

Section: Introductionmentioning

confidence: 99%

Burden of Aortic Aneurysm and Its Attributable Risk Factors from 1990 to 2019: An Analysis of the Global Burden of Disease Study 2019

Wang

You

Yin

et al. 2022

Front. Cardiovasc. Med.

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BackgroundGlobal and national estimates on the epidemiology of aortic aneurysms are prerequisites for disease management and policymaking. Based on the Global Burden of Disease (GBD) 2019, this study aimed to discern the global aortic aneurysm burden by systematically analyzing demographic data on mortality and exploring the attributable risks and relevant factors.MethodsThe data analyzed in this study were available in the Global Health Data Exchange (GHDx) online query tool. The population in our study comprised individuals from 204 countries and territories from 1990 to 2019. The estimated annual percentage changes (EAPCs) were performed to assess the temporal trends of aortic aneurysms and their attributable risks. Spearman correlation analysis was performed to explore the relationship between the burden of aortic aneurysm and covariates.ResultsAlthough aortic aneurysm-related deaths (82.1%) and disability-adjusted life years (DALYs) (67%) increased from 1990 to 2019, the global trend of age-standardized rate of death (ASRD) (EAPC: −1.34, 95% CI = −1.46 to −1.22, P < 0.001) and age-standardized rate of DALY (ASDALYR) (EAPC: −1.06, 95% CI = −1.17 to −0.95, P < 0.001) decreased, both of which presented age dependence and gender differences. Smoking and high systolic blood pressure (SBP) were the main attributable risks of disease burden and tend to decease globally (EAPC: −1.89, 95% CI = −2.03 to −1.89, P < 0.001; −1.31 95% CI = −1.43 to −1.19, P < 0.001, respectively). Alcohol abstinence (male: R = −0.71, P < 0.001; female: R = −0.73, P < 0.001), smoking age of initiation (male: R = −0.32, P < 0.001; female: R = −0.50, P < 0.001), physical activity (male: R = −0.50, P < 0.001; female: R = −0.55, P < 0.001), and mean temperature (R = −0.62, P < 0.001) had negative correlation with ASRD. However, cholesterol level (male: R = 0.62, P < 0.001; female: R = 0.39, P < 0.001), body mass index (BMI) (male: R = 0.30, P < 0.001; female R = −0.01, P > 0.05), and alcohol consumption (male: R = 0.46, P < 0.001; female: R = 0.42, P < 0.001) had a positive correlation with ASRM. Besides, standard of living and medical resources positively related to burden of aortic aneurysm.ConclusionIn this study, a decreasing trend of aortic aneurysm burden was found globally, especially in advanced regions. Aged men who smoke and women who have hypertension should pay close attention to, particularly in deprived economic groups, and many approaches can be performed to reduce the burden of aortic aneurysms.

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“…Aortic diseases, including aneurysms and dissections, are a leading and growing cause of death worldwide: Globally, the number of aortic aneurysm deaths increased to 172,426 in 2019, a rise of 82.1% compared with 1990 ( 5 ). The climbing death rate is even more pronounced in developing countries, with an increase in median death rate (per 100,000) of 0.71, three times higher than in the developed world, where it is 0.22 ( 6 ).…”

Section: Discussionmentioning

confidence: 99%

The contemporary design of endovascular aneurysm stent-graft materials: PTFE versus polyester

2022

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Endovascular aneurysm repair of the abdominal aorta (EVAR) and of the thoracic aorta (TEVAR) have revolutionised therapeutic strategies in the management of aortic pathology, and endovascular repair is now an established and attractive alternative to open surgical repair (OSR) due to its superior short-term safety profile. However, opinions are divided regarding its long-term cost-effectiveness, which is reflected in the controversial NICE guidelines on abdominal aortic aneurysm (AAA) repair published in 2018, which advised against EVAR for elective aortic repair due to high secondary intervention rates and resultant associated costs. There is no doubt that OSR continues to have a valuable role to play in aortic repair, but it is not universally applicable, especially in older and sicker patients. Therefore, we should not dismiss EVAR and TEVAR without examining the reasons for long-term failure, and the most obvious starting point is stent graft material properties. Polytetrafluoroethylene (PTFE) and polyester are the two most common stent-graft materials; however, there has been no objective comparison of PTFE and polyester stent-graft post-procedural outcomes in EVAR and TEVAR, or even OSR. This lack of definitive data on different stent-graft materials and their configuration necessitates a comprehensive review to elucidate the post-procedural outcome in terms of endograft failure, cardiovascular events, and aortic-related mortality and morbidity.

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

Cited by 23 publications

References 56 publications

Incidence and Outcomes of Abdominal Aortic Aneurysm Repair in New Zealand from 2001 to 2021

Incidence and Outcomes of Abdominal Aortic Aneurysm Repair in New Zealand from 2001 to 2021

Burden of Aortic Aneurysm and Its Attributable Risk Factors from 1990 to 2019: An Analysis of the Global Burden of Disease Study 2019

The contemporary design of endovascular aneurysm stent-graft materials: PTFE versus polyester

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