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, 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

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://ichgcp.net/clinical-trials-registry/NCT00662480, DANCAVAS: ISRCTN12157806, URL: http://www.isrctn.com/ISRCTN12157806.

Keywords: abdominal aortic aneurysms; prevalence; progression; screening; smoking; survival.

Conflict of interest statement

Dr Lars Frost reports personal fees from Bayer, Boehringer Ingelheim, BMS, MSD, and Pfizer, outside the submitted work. The authors report no other conflicts of interest in this work.

© 2020 Lindholt et al.

Figures

Figure 1
Figure 1
Five-year cumulative aneurysmal repair for men with screen-detected abdominal aortic aneurysm in the 1990s versus the 2000s (Age adj. HR = 1.29, 95% C.I.: 0.95; 1.71, p=0.10).
Figure 2
Figure 2
Five-year mortality of men detected with abdominal aortic aneurysm in the 1990s versus the 2000s regarding overall mortality (Age-adjusted HR= 0.277, 95% C.I.: 0.215; 0.356, p

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