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
I disclose the following financial relationships: Receive grant/research support from Aneurysmal Pathology Foundation (APF)
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--2014 update: a report from the American Heart Association. Circulation 2014. 2 Lederle FA. The rise and fall of abdominal aortic aneurysm. Circulation 2011. 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 2011. 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.
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.
Characteristics by sex of subjects screened for AAA Characteristic Women Men P value No. (%) 198 (36.6) 343 (63.4) Age ± SD 78.6 ± 3.8 74.1 ± 5.8 Height (m) ± SD 1.61 ± 0.07 1.74 ± 0.07 Weight (kg) ± SD 63.6 ± 10.5 81.1 ± 13.6 BMI ± SD 24.5 ± 4.0 26.7 ± 3.9 <0.0001 Family history of AAA (%) 6.1 5.8 1 Current smokers (%) 9.1 7.8 0.631 Past smokers (%) <20 years since cessation (%) 20 years since cessation (%) 16.7 3.6 13.1 47.9 14.0 33.9 <0.0001 <0.0001 <0.0001 Never smoker (%) 74.2 44.3 <0.0001 High cholesterol (%) 64.1 62.8 0.781 Hypertension (%) 61.1 58.3 0.527 Diabetes (%) 12.6 18.1 0.114 Heart disease (%) 28.3 31.8 0.438 Peripheral artery disease (%) 4.5 7.0 0.270 Respiratory disease (%) 12.1 14.3 0.516 Stroke (%) 11.1 7.9 0.216 Renal insufficiency (%) 4.0 1.5 0.079 Inguinal hernia (%) 3.0 21.3 <0.0001 Varicose veins (%) 34.3 17.8 <0.0001
Prevalence of AAA 12 10.84 (18) 10 Percentage 8 6 4.62 (25) 6.71 (23) 4 2.82 (5) 2 0 1.01 (2) Both Sexes Women Men Men (65-74) Men (75-85) One invited person who declined our invitation died from ruptured AAA.
Ectasia of Infrarenal Abdominal Aorta (Incipient AAA : < 3.0 cm) Both Sexes Women Men Subjects, n 541 198 343 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)
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 ± 5.0 73.9 ± 5.8 0.004 Height (m) ± SD 1.76 ± 0.06 1.74 ± 0.07 0.060 Weight (kg) ± SD 85.4 ± 14.0 80.8 ± 13.6 0.136 BMI ± SD 27.4 ± 4.3 26.6 ± 3.8 0.392 Family history of AAA (%) 8.7 5.6 0.634 Current smokers (%) 17.4 7.2 0.095 Past smokers (%) <20 years since cessation (%) 20 years since cessation (%) 52.2 21.7 30.5 47.5 13.4 34.1 0.673 0.344 0.657 Never smoker (%) 30.4 45.3 0.196 High cholesterol (%) 87.0 60.9 0.013 Hypertension (%) 60.9 58.1 0.803 Diabetes (%) 21.7 17.8 0.804 Heart disease (%) 52.2 30.3 0.037 Peripheral artery disease (%) 13.0 6.6 0.389 Respiratory disease (%) 21.8 13.8 0.349 Stroke (%) 17.4 7.2 0.095 Renal insufficiency (%) 0.0 1.6 1 Inguinal hernia (%) 26.1 20.9 0.598 Varicose veins (%) 34.8 16.6 0.043 Other major illness (%) 13.0 10.6 0.725
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.