Cardiovascular Disease and Mortality in Older Adults with Small Abdominal Aortic Aneurysms Detected by Ultrasonography: The Cardiovascular Health Study

Cardiovascular Disease and Mortality in Older Adults with Small Abdominal Aortic Aneurysms Detected by Ultrasonography: The Cardiovascular Health Study

From University of Pittsburgh, Pittsburgh, Pennsylvania; University of Washington, Seattle, Washington; Wake Forest University, Winston-Salem, North Carolina; Tufts–New England Medical Center, Boston, Massachusetts; and National Heart, Lung, and Blood Institute, Bethesda, Maryland.

Abstract

Background: Persons with abdominal aortic aneurysm are more likely to have a higher prevalence of risk factors for and clinical manifestations of cardiovascular disease. It is unknown whether these factors explain the high mortality rate associated with abdominal aortic aneurysm.

Objective: To describe the risk for mortality, cardiovascular mortality, and cardiovascular morbidity in persons screened for abdominal aortic aneurysm.

Design: Longitudinal cohort study.

Setting: Four communities in the United States.

Participants: 4734 men and women older than 65 years of age recruited from Medicare eligibility lists.

Measurements: Abdominal ultrasonography was used to measure the aortic diameter and the ratio of infrarenal to suprarenal measurement of aortic diameter in 1992–1993. Abdominal aortic aneurysm was defined as aortic diameter of 3 cm or greater or infrarenal-to-suprarenal ratio of 1.2 or greater. Mortality, cardiovascular disease mortality, incident cardiovascular disease, and repair or rupture were assessed after 4.5 years.

Results: The prevalence of aneurysm was 8.8%, and 87.7% of aneurysms were 3.5 cm or less in diameter. Rates of total mortality (65.1 vs. 32.8 per 1000 person-years), cardiovascular mortality (34.3 vs. 13.8 per 1000 person-years), and incident cardiovascular disease (47.3 vs. 31.0 per 1000 person-years) were higher in participants with aneurysm than in those without aneurysm; after adjustment for age, risk factors, and presence of other cardiovascular disease, the respective relative risks were 1.32, 1.36, and 1.57. Rates of repair and rupture were low.

Conclusions: Rates of total mortality, cardiovascular disease mortality, and incident cardiovascular disease were higher in participants with abdominal aortic aneurysm than in those without aneurysm, independent of age, sex, other clinical cardiovascular disease, and extent of atherosclerosis detected by noninvasive testing. Persons with smaller aneurysms detected by ultrasonography should be advised to modify risk factors for cardiovascular disease while under surveillance for increase in the size of the aneurysm.

Article and Author Information

Requests for Single Reprints: Anne B. Newman, MD, MPH, Division of Geriatric Medicine, University of Pittsburgh School of Medicine, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA 15213; e-mail, anewman+{at}pitt.edu.
Current Author Addresses: Dr. Newman: Division of Geriatric Medicine, University of Pittsburgh School of Medicine, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA 15213.
Dr. Arnold: Cardiovascular Health Study, University of Washington, 1501 Fourth Avenue, Suite 2105, Seattle, WA 98101.
Dr. Burke: Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27153.
Dr. O'Leary: Tufts–New England Medical Center, 750 Washington Street, Boston, MA 02111.
Dr. Manolio: National Heart, Lung, and Blood Institute, 6701 Rockledge Drive, MSC 7934, Bethesda, MD 20892-7934.
Author Contributions: Conception and design: A.B. Newman, G.L. Burke, D.H. O'Leary, T.A. Manolio.
Analysis and interpretation of the data: A.B. Newman, A.M. Arnold, G.L. Burke, D.H. O'Leary, T.A. Manolio.
Drafting of the article: A.B. Newman, A.M. Arnold, D.H. O'Leary.
Critical revision of the article for important intellectual content: A.B. Newman, G.L. Burke, D.H. O'Leary, T.A. Manolio.
Final approval of the article: A.B. Newman, A.M. Arnold, G.L. Burke, D.H. O'Leary, T.A. Manolio.
Provision of study materials or patients: A.B. Newman, G.L. Burke, D.H. O'Leary.
Statistical expertise: A.B. Newman, A.M. Arnold.
Obtaining of funding: A.B. Newman, G.L. Burke, D.H. O'Leary, T.A. Manolio.
Administrative, technical, or logistic support: D.H. O'Leary, T.A. Manolio.
Collection and assembly of data: D.H. O'Leary.