Current Smokers Are More Likely to Develop Abdominal Aortic Aneurysm

At least 1 in 17 middle-aged adults and 1 in 9 middle-aged current smokers developed abdominal aortic aneurysm (AAA) in their lifetime, according to a new study. Smoking cessation reduced the lifetime risk of AAA.

“Although smoking is the most important risk factor for AAA, there are limited data on how smoking cessation contributes to the reduction of AAA risk in smokers,” the researchers said.
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In the Atherosclerosis Risk in Communities (ARIC) study, 15,792 participants were recruited at visit 1 in 1987-1989 and followed up through 2013. The investigators defined longitudinal smoking status using smoking behavior ascertained from visit 1 (1987-1989) to visit 4 (1996-1998). They followed up participants for incident, clinical AAAs using hospital discharge diagnoses, Medicare outpatient diagnoses, or death certificates through 2011, and they identified 590 incident AAAs.

The researchers conducted abdominal ultrasonography in 2011-2013 in 5911 surviving participants and identified 75 asymptomatic AAAs. The researchers estimated the lifetime risk of AAA from the index age of 45 years through 85 years. At age 45, the lifetime risk for AAA was 5.6%, and 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 with continuous smokers but had a higher risk than pre-visit 1 quitters. The lifetime risk of rupture or medical intervention was 1.6%. Smoking, white race, male sex, greater height, and greater low-density lipoprotein or total cholesterol levels were associated with an increased risk of clinical and asymptomatic AAA.

“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,” the researchers said. “By all means, the best preventive strategy to reduce AAA risk in smokers is to stop smoking.”

The investigators will continue studying risk factors for AAA, including those that predispose to AAA rupture, said study lead author Weihong Tang, PhD, MS, MD, associate professor of epidemiology and community health at the University of Minnesota, Minneapolis.

—Mike Bederka

Reference:

Tang W, Yao L, Roetker NS, et al. Lifetime risk and risk factors for abdominal aortic aneurysm in a 24-year prospective study: the ARIC study (Atherosclerosis Risk in Communities) [published online November 10, 2016]. Arterioscler Thromb Vasc Biol. doi:10.1161/ATVBAHA.116.308147.