Preliminary data from the Liège Screening Programme Suggests the Reported Decline in AAA Prevalence is not Global

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1 Preliminary data from the Liège Screening Programme Suggests the Reported Decline in AAA Prevalence is not Global Georgios Makrygiannis, MD Department of Cardiovascular Surgery, and Surgical Research Center, GIGA-Cardiovascular Unit, University Hospital of Liège, Liège, Belgium

2 I disclose the following financial relationships: Receive grant/research support from Aneurysmal Pathology Foundation (APF)

3 Backround and Aim of the Study Evident benefit in terms of mortality from screening for Abdominal Aortic Aneurysm (AAA) among men aged over 65. AAA prevalence: 1.3% to 12.5% in men, 0% to 5.2% in women. 1 Recent studies from USA, UK and Sweden: decrease in the prevalence of AAA in the general population. 2 Whether these findings are generalizable for the rest of Europe is unknown. We decided to set up a screening program in order to detect AAA in 10,000 inhabitants in Liège, Belgium, Western Europe. 1 Go et al. Heart desase and stroke statistics update: a report from the American Heart Association. Circulation Lederle FA. The rise and fall of abdominal aortic aneurysm. Circulation Svensjo S. et al. Low prevalence of abdominal aortic aneurysm among 65-year-old Swedish men indicates a change in the epidemiology of the disease. Circulation Anjum A, Powell JT. Is the incidence of abdominal aortic aneurysm declining in the 21st century? Mortality and hospital admissions for England & Wales and Scotland. Eur J Vasc Endovasc Surg 2012.

4 Materials & Methods (Ongoing study) 3,056 Invitations (County of Chaudfontaine): 1,850 men (65 85), 1,206 (74 85) women. Usual Risk Factors Questionnaires Sent to Invited Persons. First 3-month period (May-July 2014). 541 subjects: 198 women, 343 men. Definition of AAA: Abdominal aortic diameter 3 cm (McGregor JC et al. Scott. Med. J. 1975). Measurement of maximal Suprarenal/Infrarenal aorta and Common Iliac arteries by portable ultrasonographic device (outer-to-outer method). Measurement of Arm and Ankle Blood Pressure. Carotid Auscultation.

5 Characteristics by sex of subjects screened for AAA Characteristic Women Men P value No. (%) 198 (36.6) 343 (63.4) Age ± SD 78.6 ± ± 5.8 Height (m) ± SD 1.61 ± ± 0.07 Weight (kg) ± SD 63.6 ± ± 13.6 BMI ± SD 24.5 ± ± 3.9 < Family history of AAA (%) Current smokers (%) Past smokers (%) <20 years since cessation (%) 20 years since cessation (%) < < < Never smoker (%) < High cholesterol (%) Hypertension (%) Diabetes (%) Heart disease (%) Peripheral artery disease (%) Respiratory disease (%) Stroke (%) Renal insufficiency (%) Inguinal hernia (%) < Varicose veins (%) <0.0001

6 Prevalence of AAA (18) 10 Percentage (25) 6.71 (23) (5) (2) Both Sexes Women Men Men (65-74) Men (75-85) One invited person who declined our invitation died from ruptured AAA.

7 Ectasia of Infrarenal Abdominal Aorta (Incipient AAA : < 3.0 cm) Both Sexes Women Men Subjects, n Ectasia of Infrarenal Aorta, n, (%) 24, (4.44) 2, (1.01) 22, (6.41) 2.5 cm, n, (%) 6, (1.11) 0, (0) 6, (1.75) 2.6 cm, n, (%) 6, (1.11) 0, (0) 6, (1.75) 2.7 cm, n, (%) 6, (1,11) 1, (0.51) 5, (1.81) 2.8 cm, n, (%) 3, (0,55) 0, (0) 3, (0.88) 2.9 cm, n, (%) 3, (0.55) 1, (0.51) 2, (0.58)

8 Comparison of risk factor profiles and characteristics between men with and without AAA Variable Men with AAA n=23 Men without AAA n=320 P value Age ± SD 77.4 ± ± Height (m) ± SD 1.76 ± ± Weight (kg) ± SD 85.4 ± ± BMI ± SD 27.4 ± ± Family history of AAA (%) Current smokers (%) Past smokers (%) <20 years since cessation (%) 20 years since cessation (%) Never smoker (%) High cholesterol (%) Hypertension (%) Diabetes (%) Heart disease (%) Peripheral artery disease (%) Respiratory disease (%) Stroke (%) Renal insufficiency (%) Inguinal hernia (%) Varicose veins (%) Other major illness (%)

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10 Conclusion Despite a reported declining prevalence of AAA in some recent population-based studies, we found that the prevalence of AAA in Liège population remains high in men aged 65 years or more. The prevalence of AAA seems to vary in different geographical regions. However, we need a larger sample to confirm our preliminary findings.