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 Guidelines already recommend screening men over age 65 who have ever
smoked for abdominal aortic aneurysm, a life-threatening condition,
but it may be time to give women the same advice, the authors say.
“Smoking is a major risk factor for abdominal aortic aneurysm (AAA)
and the risk appears to be as strong among women,” said lead author
Dr. Eiman Jahangir, a senior lecturer with the University of
Queensland School of Medicine-Ochsner Clinical School program in New
Orleans.
AAA occurs when a person’s aorta, the biggest blood vessel in the
body, swells to a larger size. The aorta runs from the heart through
the abdomen delivering blood to much of the body.
Symptoms of an abdominal aortic aneurysm may include a pulsing
feeling, swelling or pain in the stomach area.
While the condition can be treated with surgery, “the risk is that
they can continue to grow and burst, which is usually fatal,” said
Dr. Vimal Gokani, a clinical research fellow at the British Heart
Foundation in London who was not involved in the study.
Most cases of aneurysm occur in people over 65 and Gokani noted in
an email that as the population ages, the problem is likely to
become more common.
According to the Centers for Disease Control and Prevention, more
than 10,000 people in the U.S. die each year from AAA. Jahangir and
colleagues write in the Journal of Epidemiology and Community Health
that it’s the 16th leading cause of death for seniors.
The study team analyzed data from a long term study of people in the
U.S. South. They focused on a total of 18,792 participants who were
over 65 and had Medicare coverage. Participants answered
questionnaires including information about demographics, tobacco use
and personal and family health histories.
The researchers compared this information with Medicare records to
determine that 281 people had suffered aneurysms during the study
period.
Men were twice as likely as women to have aneurysms and whites were
2.5 times more likely than blacks to experience the condition.
Smoking was the strongest risk factor, however, with former smokers
– both men and women - facing almost twice the risk of never
smokers, and current smokers facing an overall risk five and a half
times that of never smokers.
The difference smoking made was especially pronounced among women,
with former smokers having three and a half times the risk of women
who had never smoked and current smokers having nine times the risk
of women who had never smoked.
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The researchers note that this is problematic, as aneurysms are more
often severe when they happen to women.
Having high blood pressure or a history of heart surgery also
increased the risk of aneurysm, while being overweight was linked to
a lowered risk. Gokani noted that having a family history of
aneurysm and high cholesterol can also increase a person’s risk.
Currently, men between the ages of 65 and 75 who have ever smoked
are advised to have a one-time screening ultrasound to check for
aneurysm, according to Jahangir. He said that women are not
currently included in these recommendations and “more studies need
to be done to see if women would also benefit from screening
ultrasound for AAA.”
Both Jahangir and Gokani said that quitting smoking will likely
reduce the risk of aneurysm. “Smoking cessation is very difficult,
but so important,” Gokani said.
He cited recent research showing that when smoking rates in a
country are lowered, the rates of aneurysm go down as well.
Jahangir advises men ages 65-75 who have ever smoked to get an
abdominal ultrasound and advises women to talk to their doctors
about whether a screening is recommended.
If an aneurysm is found, Gokani recommends that people should stop
smoking and “seek medical advice to ensure that their blood pressure
is under control, that their cholesterol levels are normal.”
SOURCE: http://bmj.co/1DFb6zT Journal of Epidemiology and Community
Health, online January 6, 2015.
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