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Clinical risk indicators for formation of abdominal aortic aneurysms

English version

Klinische Risikoindikatoren für die Entstehung abdominaler Aortenaneurysmen

Abstract

Background

Evidence for ultrasound screening of abdominal aortic aneurysms (AAA) has been confirmed in several international studies. The efficiency could be increased by taking into account additional information about risk factors and secondary diagnoses to reduce the number of persons to be examined.

Material and methods

Population-based studies from 2000 to 2014 concerning AAA screening were analyzed under the aspect of clinical risk factors. All randomized controlled studies (RCT) for AAA screening and health technology assessment (HTA) reports about clinical risk indicators were analyzed. The following variables were looked for: age, gender, smoking, family history, cardiovascular disease, peripheral arterial occlusive disease (PAOD), hypertension, obesity, chronic obstructive pulmonary disease (COPD), hypercholesterolemia and diabetes mellitus. In addition, a short survey of rarely studied clinical variables is given.

Results

For the following risk factors a positive correlation for the development of AAA was found: body mass index (BMI), increasing age, male gender, nicotine history and a positive family history for AAA. Coronary artery disease (CAD), COPD and PAOD as comorbidities represent a significantly increased prevalence of AAA. Uncertain results and insufficient research results exist for obesity, hypercholesterolemia, COPD, physical activity and nutrition. The risk factors diabetes mellitus, non-white skin color as well as feminine sex were associated with a decreased probability of AAA.

Discussion

Many of the known risk factors for atherosclerosis are also associated with an increased prevalence of AAA; however, this is not always true. For example, female sex, diabetes mellitus and certain increases in fat metabolism are associated with a decreased prevalence. For female sex a differentiated approach should be recommended as a more sophisticated analysis is able to identify significant risk factors that need to be taken into account because women have a significantly increased risk of rupture and form a large proportion of the cases of rupture. A sophisticated algorithm for the identification of individuals who would benefit from individualized indications for aortic screening could reduce the number needed to screen per identified aortic aneurysm.

Conclusion

In consideration of evident clinical risk factors, further groups of patients could be defined which could particularly benefit from AAA screening. Under this aspect, population-based prospective studies are necessary.

Zusammenfassung

Hintergrund

Die Evidenz eines Ultraschallscreenings auf abdominale Aortenaneurysmata (AAA) ist in mehreren randomisierten Studien belegt worden. Die Effizienz eines Screenings könnte durch die Berücksichtigung klinischer Risikoindikatoren erhöht werden.

Material und Methoden

Analyse populationsbasierter Studien aus dem Zeitraum 2000 bis 2014 zum Screening des abdominalen Aortenaneurysmas (AAA) hinsichtlich klinischer Risikoindikatoren. Außerdem wurden alle RCTs zum AAA-Screening und Health-Technology-Assessment- (HTA-)Berichte hinsichtlich klinischer Risikoindikatoren analysiert. Folgende klinische Variablen wurden analysiert: Lebensalter, Geschlechtszugehörigkeit, Nikotinabusus, Familienanamnese, kardiovaskuläre Erkrankungen, periphere arterielle Verschlusskrankheit (PAVK), arterielle Hypertonie, Adipositas, chronisch-obstruktive Lungenerkrankung (COPD), Hyperlipoproteinämie und Diabetes mellitus. Darüber hinaus wird eine kurze Übersicht zu bisher wenig untersuchten klinischen Variablen gegeben.

Ergebnisse

Signifikante Risikofaktoren für die Entstehung eines AAA sind ein zunehmendes Lebensalter, männliches Geschlecht, Nikotinabusus und AAAs in der familiären Anamnese. Weitere mögliche Risikofaktoren sind: kardiovaskuläre Erkrankungen (insbesondere koronare Herzkrankheit), arterielle Hypertonie und das Vorliegen einer peripheren arteriellen Verschlusskrankheit. Unsichere und unzureichend untersuchte Risikofaktoren sind: Adipositas, Hyperlipoproteinämie, chronisch-obstruktive Lungenerkrankung, körperliche Aktivität und Ernährungsgewohnheiten. Folgende klinischen Variablen sind mit einer geringeren Wahrscheinlichkeit eines AAA assoziiert: weibliches Geschlecht, nicht weiße Hautfarbe und Diabetes mellitus.

Schlussfolgerungen

Die Berücksichtigung evidenter klinischer Risikofaktoren könnte weitere Patientengruppen definieren, die in besonderem Maße von einem AAA-Screening profitieren könnten. Hierzu sind populationsbasierte prospektive Studien notwendig.

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Compliance with ethical guidelines

Conflict of interest. I. Flessenkämper, H. Söllner, and H.-H. Eckstein declare that there are no conflicts of interest. This paper does not include any studies on humans or animals.

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Correspondence to I. Flessenkämper.

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The German version of this article is published in Gefässchirurgie (2014) 19:549–557.

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Flessenkämper, I., Söllner, H. & Eckstein, HH. Clinical risk indicators for formation of abdominal aortic aneurysms. Gefässchirurgie 20, 13–21 (2015). https://doi.org/10.1007/s00772-014-1400-4

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Keywords

  • Abdominal aortic aneurysm
  • Screening
  • Risk factors
  • Comorbidity
  • Population based

Schlüsselwörter

  • Abdominales Aortenaneurysma
  • Screening
  • Risikofaktoren
  • Nebenerkrankungen
  • Populationsbasiert