Sex differences in the association between smoking and abdominal aortic aneurysm

Stackelberg, Otto; Björck, Martin; Larsson, Susanna C.; Orsini, Nicola; Wolk, Alicja

doi:10.1002/bjs.9526

Cited by 55 publications

(24 citation statements)

References 32 publications

(36 reference statements)

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“…Some studies suggest that the association between smoking and AAA is stronger in women than men 11 , which is consistent with findings that compared to male smokers, women who smoke seem to be more susceptible to lung cancer 12 , myocardial infarction 13 , and stroke 14 too. Additionally, a large body of evidence suggests that women have a harder time quitting smoking than men.…”

Section: Epidemiologysupporting

confidence: 74%

“…The incidence of AAA among women age 65 or older who have ever smoked may be higher than that in their non-smoking male counterparts 11 , who may nevertheless be offered screening based on the current USPST recommendations. In line with these considerations, the SVS recommends screening women age 65 or older who have smoked or have a family history 19 .…”

Section: Screeningmentioning

confidence: 97%

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Abdominal aortic aneurysms in women

Schermerhorn

2016

Journal of Vascular Surgery

133

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Abdominal aortic aneurysm (AAA) has long been recognized as a condition predominantly afflicting males, with sex-associated differences described for almost every aspect of the disease from pathophysiology and epidemiology to morbidity and mortality. Women are generally spared from AAA formation by the immunomodulating effects of estrogen but once they develop, the natural history of AAAs in women appears to be more aggressive, with more rapid expansion, a higher tendency to rupture at smaller diameters, and higher mortality following rupture. However, simply repairing AAA at smaller diameters in women is a debatable solution, as even elective endovascular AAA repair (EVAR) is fraught with higher morbidity and mortality in women compared to men. The goal of this review is to summarize what is currently known about the effect of gender on AAA presentation, treatment, and outcomes. Additionally, we aim to review current controversies over screening recommendations and threshold for repair in women.

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Section: Epidemiologysupporting

confidence: 74%

Section: Screeningmentioning

confidence: 97%

Abdominal aortic aneurysms in women

Schermerhorn

2016

Journal of Vascular Surgery

133

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“…Our unique data on lifetime risk of AAA expands the previous report of an increased risk of AAA for women smokers over a median follow-up of 4.9 years 15 and another report of a higher incidence of AAA in women smokers than in men who never smoked during a mean of 12.7 years of follow-up. 22 These data may be useful to policy makers in considering preventive strategies for female smokers in the future. Our data also indicate that physicians may need to pay similar attention in monitoring female current smokers for the occurrence of AAA as to male ever smokers after they pass middle age.…”

Section: Discussionmentioning

confidence: 98%

Lifetime Risk and Risk Factors for Abdominal Aortic Aneurysm in a 24-Year Prospective Study

Tang

Roetker

et al. 2016

ATVB

116

115

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Objective Abdominal aortic aneurysm (AAA) is an important vascular disease in older adults but data on lifetime risk of AAA are sparse. We examined lifetime risk of AAA in a community-based cohort and prospectively assessed the association between mid-life cardiovascular risk factors and AAAs. Approach and Results In ARIC, 15,792 participants were recruited at Visit 1 in 1987–89 and followed-up through 2013. Longitudinal smoking status was defined using smoking behavior ascertained from Visit 1 (1987–89) to Visit 4 (1996–1998). We followed participants for incident, clinical AAAs using hospital discharge diagnoses, Medicare outpatient diagnoses, or death certificates through 2011 and identified 590 incident AAAs. An abdominal ultrasound was conducted in 2011–2013 in 5,911 surviving participants and 75 asymptomatic AAAs were identified. We estimated the lifetime risk of AAA from the index age 45 years through age 85. At age 45, the lifetime risk for AAA was 5.6% (95% confidence interval: 4.8–6.1) and was higher in men (8.2%) and current smokers (10.5%). Smokers who quit smoking between Visit 1 and Visit 4 had a 29% lower AAA lifetime risk compared to continuous smokers but had a higher risk than pre-Visit 1 quitters. The lifetime risk of rupture or medical intervention was 1.6% (95% CI: 1.2, 1.8). Smoking, white race, male gender, and greater height, LDL or total cholesterol were associated with an increased risk of clinical AAA and asymptomatic AAA. Conclusions At least one in 9 middle-aged current smokers developed AAA in their lifetime. Smoking cessation reduced the lifetime risk of AAA.

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“…Current smokers have a significantly higher risk of developing AAA in both women and men than those who have never smoked [33]. Smoking also increases AAA growth, causing a greater risk of rupture and poor prognosis [34].…”

Section: Discussionmentioning

confidence: 99%

Association of Polymorphisms of the Receptor for Advanced Glycation End Products Gene and Susceptibility to Sporadic Abdominal Aortic Aneurysm

Yao

Zhuang

You

et al. 2015

BioMed Research International

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Accumulating evidence has suggested that receptor for advanced glycation end products (RAGE) is involved in the development and progression of human abdominal aortic aneurysms (AAAs). However, the association between RAGE gene polymorphisms and AAA has not yet been determined. The present study was aimed at analyzing the potential association between the RAGE gene polymorphisms and AAAs. A cohort of 381 patients and 436 age-matched healthy controls were genotyped to detect the three RAGE polymorphisms (−374 T/A, −429 T/C, and G82S) using SNaPshot. Our study demonstrated a significant difference in the genotype and allele frequencies of the RAGE G82S polymorphism between the AAA patients and the controls. Further stratification by gender and smoking status revealed that the presence of the RAGE 82S allele confers a higher risk for developing AAA in men and smokers. Moreover, AAA patients with the variant 82S allele of RAGE presented with reduced serum soluble RAGE (sRAGE) production, and this decrease was more significant in men and smokers with AAA. Our study provides preliminary evidence that the 82S allele of RAGE is a risk factor for AAA. This new piece of knowledge regarding RAGE may be clinically important for the prevention and therapy of AAAs.

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Sex differences in the association between smoking and abdominal aortic aneurysm

Abstract: There were sex differences in the associations between smoking status and AAA risk. These data support further investigation of targeted AAA screening among women who smoke.

Cited by 55 publications

References 32 publications

Abdominal aortic aneurysms in women

Abdominal aortic aneurysms in women

Lifetime Risk and Risk Factors for Abdominal Aortic Aneurysm in a 24-Year Prospective Study

Association of Polymorphisms of the Receptor for Advanced Glycation End Products Gene and Susceptibility to Sporadic Abdominal Aortic Aneurysm

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