Abdominal aortic aneurysm risk factors: Difference between revisions
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* Small aneurysms can rupture as well, and are threefold more likely to rupture in women | * Small aneurysms can rupture as well, and are threefold more likely to rupture in women | ||
* Localized outpouchings seems to increase the aneurysm's vulnerability for rupture | * Localized outpouchings seems to increase the aneurysm's vulnerability for rupture | ||
* It has been suggested that the aneurysm growth and rupture correlate with the growth of the aneurysm's mural [[thrombus]]: the part of the aneurysm wall that is covered with thrombus has been shown to be thinner and showed focal [[anoxia]], [[inflammation]], [[apoptosis]] of the [[smooth muscle cell]]s, and degraded extracellular matrix than wall segments not covered by the [[thrombus]]. | * It has been suggested that the aneurysm growth and rupture correlate with the growth of the aneurysm's mural [[thrombus]]: the part of the aneurysm wall that is covered with thrombus has been shown to be thinner and showed focal [[anoxia]], [[inflammation]], [[apoptosis]] of the [[smooth muscle cell]]s, and a more degraded extracellular matrix than wall segments not covered by the [[thrombus]]. | ||
==2005 ACC/AHA Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) (DO NOT EDIT)<ref name="pmid16549646">{{cite journal |author=Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B |title=ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation |journal=[[Circulation]] |volume=113 |issue=11 |pages=e463–654 |year=2006 |month=March |pmid=16549646 |doi=10.1161/CIRCULATIONAHA.106.174526 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16549646 |accessdate=2012-10-09}}</ref>== | ==2005 ACC/AHA Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) (DO NOT EDIT)<ref name="pmid16549646">{{cite journal |author=Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B |title=ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation |journal=[[Circulation]] |volume=113 |issue=11 |pages=e463–654 |year=2006 |month=March |pmid=16549646 |doi=10.1161/CIRCULATIONAHA.106.174526 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16549646 |accessdate=2012-10-09}}</ref>== | ||
Revision as of 14:33, 21 November 2012
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Abdominal Aortic Aneurysm Microchapters |
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Differentiating Abdominal Aortic Aneurysm from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Abdominal aortic aneurysm risk factors On the Web |
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Directions to Hospitals Treating Abdominal aortic aneurysm risk factors |
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Risk calculators and risk factors for Abdominal aortic aneurysm risk factors |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Vishnu Vardhan Serla M.B.B.S. [3]
Overview
The most significant modifiable risk factor for the development of an abdominal aortic aneurysm is smoking which increases the risk of aneurysm development 8 fold. Advanced age and family history are the strongest non-modifiable risk factors for the development of an abdominal aortic aneurysm. Hypercholesterolemia and hypertension are risk factors as well. Both diabetes mellitus and being of African American descent appear to be associated with a lower incidence of abdominal aortic aneurysm. An increased rate of expansion of abdominal aortic aneurysm is related to systolic hypertension, wide pulse pressure, and ongoing smoking. The risk of abdominal aortic aneurysm rupture is proportional to the size and rate of growth of the aneurysm. Abdominal aortic aneurysms greater than 5 cm diameter or those that grow faster than 1 cm per year have a significantly increased risk of rupture and are indications for elective operative repair. Advanced age, female gender, hypertension, active smoking, outpouchings, and mural thrombus are also risk factors for abdominal aortic aneurysm rupture.
Risk Factors for Abdominal Aortic Aneurysm Development
- The strongest independent acquired risk factor for AAA is smoking. In a study by Wilmink et. al,[1] current smokers were shown to be 7.6 times more likely to have an AAA than non smokers. The longer one has smoked, the greater the risk for an AAA, but the number of cigarettes smoked per day did not seem to correlate with risk after adjusting for duration of smoking.
- Advanced age and family history are the strongest nonreversible risk factors.
- The prevalence of abdominal aortic aneurysms among first-degree relatives of patients with abdominal aortic aneurysms ranges from 15-29%, compared with 2% among relatives of controls.
- Male sex
- Hypertension
- Known atherosclerotic disease - coronary artery disease, cerebrovascular disease, peripheral artery disease
- Hypercholesterolemia
- Chronic obstructive pulmonary disease
Cardiovascular risk factors tend to cluster in certain patients:
- Men who smoke and are hypertensive have an incidence of abdominal aortic aneurysm that is 2-5 times than those of the general population.
- Similarly, women over the age of 60 with cardiovascular risk factors are 2-3 times more likely to develop aneurysmal disease.
- Both diabetes mellitus and being of African American descent appear to be associated with a lower incidence of abdominal aortic aneurysm.
Risk Factors for Rapid Abdominal Aortic Aneurysm Expansion
- In small AAAs (3-5.4 cm), the expansion rate appears to be proportional to the initial diameter.
- Independent of the initial diameter of the aneurysm, other factors related to rapid expansion of an abdominal aortic aneurysm are:
- Systolic hypertension
- Wide pulse pressure
- Ongoing smoking
Factors not Associated with more Rapid Expansion of Abdominal Aortic Aneurysm
C-reactive protein levels have also been found to be elevated in larger aneurysms, however they do not appear to be linked to rapid expansion.
Risk Factors for Abdominal Aortic Aneurysm Rupture
The risk of rupture is proportional to the size and rate of growth of the aneurysm. Aneurysms greater than 5 cm diameter or those that grow faster than 1 cm per year have a significantly increased risk of rupture and are indications for elective operative repair.[2][3] In the UK Small Aneurysm Trial, UKref2 important independent variables were identified with abdominal aortic aneurysm rupture:
- Female sex
- Increased diameter of the abdominal aortic aneurysm
- Current smoker
- Mean blood pressure
- Increased age
- Forced expiratory volume in 1 second
- Size at diagnosis is one of the best predictors of rupture.
- The risk increases substantially when the diameter exceeds 6 cm in men and 5 cm in women.
- Small aneurysms can rupture as well, and are threefold more likely to rupture in women
- Localized outpouchings seems to increase the aneurysm's vulnerability for rupture
- It has been suggested that the aneurysm growth and rupture correlate with the growth of the aneurysm's mural thrombus: the part of the aneurysm wall that is covered with thrombus has been shown to be thinner and showed focal anoxia, inflammation, apoptosis of the smooth muscle cells, and a more degraded extracellular matrix than wall segments not covered by the thrombus.
2005 ACC/AHA Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) (DO NOT EDIT)[4]
Atherosclerotic Risk Factors of AAA (DO NOT EDIT)[4]
| Class I |
| "1. In patients with AAAs, blood pressure and fasting serum lipid values should be monitored and controlled as recommended for patients with atherosclerotic disease. (Level of Evidence: C)" |
| "2. Patients with aneurysms or a family history of aneurysms should be advised to stop smoking and be offered smoking cessation interventions, including behavior modification, nicotine replacement, or bupropion. (Level of Evidence: B)" |
References
- ↑ Wilmink TB, Quick CR, Day NE (1999). "The association between cigarette smoking and abdominal aortic aneurysms". Journal of Vascular Surgery. 30 (6): 1099–105. PMID 10587395. Unknown parameter
|month=ignored (help) - ↑ Dahnert W. Radiology Review Manual, 5th edition. Lippincott, Williams and Wilkins 2003
- ↑ Rakita D, Newatia A, Hines JJ, Siegel DN, Friedman B (2007). "Spectrum of CT findings in rupture and impending rupture of abdominal aortic aneurysms". Radiographics. 27 (2): 497–507. doi:10.1148/rg.272065026. PMID 17374865.
- ↑ 4.0 4.1 Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B (2006). "ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation". Circulation. 113 (11): e463–654. doi:10.1161/CIRCULATIONAHA.106.174526. PMID 16549646. Retrieved 2012-10-09. Unknown parameter
|month=ignored (help)