Survival, Prevalence, Progression and Repair of Abdominal Aortic Aneurysms: Results from Three Randomised Controlled Screening Trials Over Three Decades

Jes S Lindholt; Axel C Diederichsen; Lars M Rasmussen; Lars Frost; Flemming H Steffensen; Jess Lambrechtsen; Grazina Urbonaviciene; Martin Busk; Kenneth Egstrup; Katrine L Kristensen; Carsten Behr Andersen; Rikke Søgaard

doi:10.2147/CLEP.S238502

Survival, Prevalence, Progression and Repair of Abdominal Aortic Aneurysms: Results from Three Randomised Controlled Screening Trials Over Three Decades

Clin Epidemiol. 2020 Jan 23:12:95-103. doi: 10.2147/CLEP.S238502. eCollection 2020.

Authors

Jes S Lindholt^{1

2

3}, Axel C Diederichsen^{2

4}, Lars M Rasmussen^{2

5}, Lars Frost^{6

7}, Flemming H Steffensen⁸, Jess Lambrechtsen⁸, Grazina Urbonaviciene^{6

7}, Martin Busk⁹, Kenneth Egstrup⁸, Katrine L Kristensen^{1

2

3}, Carsten Behr Andersen³, Rikke Søgaard¹⁰

Affiliations

¹ Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.
² Elitary Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense, Denmark.
³ Department of Vascular Surgery, Viborg Hospital, Viborg, Denmark.
⁴ Department of Cardiology, Odense University Hospital, Odense, Denmark.
⁵ Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.
⁶ Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark.
⁷ Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
⁸ Department of Cardiology, Vejle Hospital, Vejle, Denmark.
⁹ Department of Cardiology, University Hospital Odense Svendborg, Svendborg, Denmark.
¹⁰ Department of Public Health and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.

Abstract

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; prevalence; progression; screening; smoking; survival.

Associated data

ClinicalTrials.gov/NCT00662480

Grants and funding

The Viborg study as funded by The Danish Heart Foundation, The Danish National Research Council, and The County of Viborg. The VIVA trial was funded by the 7th European framework programme: Health-2007-2.4.2-2.: Project full title: Fighting Aneurysmal disease. Grant agreement no: 200647, the Mid Region of Denmark, Viborg Hospital, and The Danish Council for Independent Research. The DANCAVAS trial is supported by The Danish Heart Foundation, The Danish Council for Independent Research, The Region of Southern Denmark, and the Helse Foundation.