Survival, Prevalence, Progression and Repair of Abdominal Aortic Aneurysms: Results from Three Randomised Controlled Screening Trials Over Three Decades
Received 13 November 2019
Accepted for publication 10 January 2020
Published 23 January 2020 Volume 2020:12 Pages 95—103
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Dr Eyal Cohen
Jes S Lindholt, 1–3 Axel C Diederichsen, 2, 4 Lars M Rasmussen, 2, 5 Lars Frost, 6, 7 Flemming H Steffensen, 8 Jess Lambrechtsen, 8 Grazina Urbonaviciene, 6, 7 Martin Busk, 9 Kenneth Egstrup, 8 Katrine L Kristensen, 1–3 Carsten Behr Andersen, 3 Rikke Søgaard 10
1Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; 2Elitary Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense, Denmark; 3Department of Vascular Surgery, Viborg Hospital, Viborg, Denmark; 4Department of Cardiology, Odense University Hospital, Odense, Denmark; 5Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark; 6Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark; 7Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; 8Department of Cardiology, Vejle Hospital, Vejle, Denmark; 9Department of Cardiology, University Hospital Odense Svendborg, Svendborg, Denmark; 10Department of Public Health and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Correspondence: Jes S Lindholt
Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J.B. Winsløv Vej 4, Odense 5000, Denmark
Tel +45 2464 1214
Aim: The prevalence and mortality of abdominal aortic aneurysms (AAA) has been reported to decline. The aim of this study is to compare survival, prevalence, and repair rate of AAA in Denmark in the 1990s, the 2000s and the 2010s – and to examine any change in factors known to influence the prevalence.
Methods: Baseline status and up to 5-year outcomes of 34,079 general population men aged 65– 74 were obtained from three RCTs; the Viborg study (1994– 1998, n=4,860), the Viborg Vascular (VIVA) trial (2008– 2011, n=18,748), and the Danish Cardiovascular (DANCAVAS) trial (2015– 2018, n=10,471). After the millennium (VIVA and DANCAVAS) men with AAA were further offered low dose aspirin and statins. Follow-up data were not available for the DANCAVAS trial yet.
Results: Across the three decades, the AAA prevalence was 3.8% (Reference), 3.3% (p< 0.001) and 4.2% (p=0.882), the proportion of smokers were 62%, 42% and 34% (p< 0.001) amongst men with AAA, but AAA risk associations with smoking increased during the decades suggesting increased tobacco consumption of smokers. In addition, the proportions of attenders with ischemic heart disease or stroke increased significantly. The aneurysmal progression rate in the 1990s was 2.90 vs 2.98 mm/year in the 2000s (p=0.91). The need for preventive AAA repair increased insignificantly in the 2000s (Age adj. HR= 1.29, 95% C.I.: 0.95; 1.71, p=0.10), and mortality of men with screen-detected AAA was lower in the 2000s compared to the 1990s (Age-adj. HR= 0.28, 95% C.I.: 0.22; 0.36, p< 0.001).
Conclusion: The Danish prevalence of AAA today compares to the nineties. Unchanged aneurysmal progression rates combined with improved survival of men at risk of AAA leave them in longer time to develop an AAA, be diagnosed and to need later aneurysmal repair or experience rupture.
Clinical Trial Registrations: Viborg study: No possibility of registration in the nineties. VIVA: NCT00662480, URL: https://clinicaltrials.gov/show/NCT00662480, DANCAVAS: ISRCTN12157806, URL: http://www.isrctn.com/ISRCTN12157806.
Keywords: abdominal aortic aneurysms, screening, prevalence, survival, progression, smoking
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