No increased mortality with early aortic aneurysm disease

Matthew Mell, Julie J. White, Bradley B. Hill, Trevor Hastie, Ronald L. Dalman

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objective: In addition to increased risks for aneurysm-related death, previous studies have determined that all-cause mortality in abdominal aortic aneurysm (AAA) patients is excessive and equivalent to that associated with coronary heart disease. These studies largely preceded the current era of coronary heart disease risk factor management, however, and no recent study has examined contemporary mortality associated with early AAA disease (aneurysm diameter between 3 and 5 cm). As part of an ongoing natural history study of AAA, we report the mortality risk associated with presence of early disease. Methods: Participants were recruited from three distinct health care systems in Northern California between 2006 and 2011. Aneurysm diameter, demographic information, comorbidities, medication history, and plasma for biomarker analysis were collected at study entry. Survival status was determined at follow-up. Data were analyzed with t-tests or χ2 tests where appropriate. Freedom from death was calculated via Cox proportional hazards modeling; the relevance of individual predictors on mortality was determined by log-rank test. Results: The study enrolled 634 AAA patients; age 76.4 ± 8.0 years, aortic diameter 3.86 ± 0.7 cm. Participants were mostly male (88.8%), not current smokers (81.6%), and taking statins (76.7%). Mean follow-up was 2.1 ± 1.0 years. Estimated 1- and 3-year survival was 98.2% and 90.9%, respectively. Factors independently associated with mortality included larger aneurysm size (hazard ratio, 2.12; 95% confidence interval, 1.26-3.57 for diameter >4.0 cm) and diabetes (hazard ratio, 2.24; 95% confidence interval, 1.12-4.47). After adjusting for patient-level factors, health care system independently predicted mortality. Conclusions: Contemporary all-cause mortality for patients with early AAA disease is lower than that previously reported. Further research is warranted to determine important factors that contribute to improved survival in early AAA disease.

Original languageEnglish (US)
Pages (from-to)1246-1251
Number of pages6
JournalJournal of Vascular Surgery
Volume56
Issue number5
DOIs
StatePublished - Nov 1 2012
Externally publishedYes

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Aortic Diseases
Aortic Aneurysm
Abdominal Aortic Aneurysm
Mortality
Aneurysm
Coronary Disease
Survival
Confidence Intervals
Delivery of Health Care
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Risk Management
Natural History
Health Status
Comorbidity
Biomarkers
Demography
Research

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

No increased mortality with early aortic aneurysm disease. / Mell, Matthew; White, Julie J.; Hill, Bradley B.; Hastie, Trevor; Dalman, Ronald L.

In: Journal of Vascular Surgery, Vol. 56, No. 5, 01.11.2012, p. 1246-1251.

Research output: Contribution to journalArticle

Mell, M, White, JJ, Hill, BB, Hastie, T & Dalman, RL 2012, 'No increased mortality with early aortic aneurysm disease', Journal of Vascular Surgery, vol. 56, no. 5, pp. 1246-1251. https://doi.org/10.1016/j.jvs.2012.04.023
Mell, Matthew ; White, Julie J. ; Hill, Bradley B. ; Hastie, Trevor ; Dalman, Ronald L. / No increased mortality with early aortic aneurysm disease. In: Journal of Vascular Surgery. 2012 ; Vol. 56, No. 5. pp. 1246-1251.
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abstract = "Objective: In addition to increased risks for aneurysm-related death, previous studies have determined that all-cause mortality in abdominal aortic aneurysm (AAA) patients is excessive and equivalent to that associated with coronary heart disease. These studies largely preceded the current era of coronary heart disease risk factor management, however, and no recent study has examined contemporary mortality associated with early AAA disease (aneurysm diameter between 3 and 5 cm). As part of an ongoing natural history study of AAA, we report the mortality risk associated with presence of early disease. Methods: Participants were recruited from three distinct health care systems in Northern California between 2006 and 2011. Aneurysm diameter, demographic information, comorbidities, medication history, and plasma for biomarker analysis were collected at study entry. Survival status was determined at follow-up. Data were analyzed with t-tests or χ2 tests where appropriate. Freedom from death was calculated via Cox proportional hazards modeling; the relevance of individual predictors on mortality was determined by log-rank test. Results: The study enrolled 634 AAA patients; age 76.4 ± 8.0 years, aortic diameter 3.86 ± 0.7 cm. Participants were mostly male (88.8{\%}), not current smokers (81.6{\%}), and taking statins (76.7{\%}). Mean follow-up was 2.1 ± 1.0 years. Estimated 1- and 3-year survival was 98.2{\%} and 90.9{\%}, respectively. Factors independently associated with mortality included larger aneurysm size (hazard ratio, 2.12; 95{\%} confidence interval, 1.26-3.57 for diameter >4.0 cm) and diabetes (hazard ratio, 2.24; 95{\%} confidence interval, 1.12-4.47). After adjusting for patient-level factors, health care system independently predicted mortality. Conclusions: Contemporary all-cause mortality for patients with early AAA disease is lower than that previously reported. Further research is warranted to determine important factors that contribute to improved survival in early AAA disease.",
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