Aneurysm Global Epidemiology Study: Public Health Measures can Further Reduce Abdominal Aortic Aneurysm Mortality
Background—Contemporary data from western populations suggest steep declines in abdominal aortic aneurysm (AAA) mortality however international trends are unclear. This study aimed to investigate global AAA mortality trends and to analyse any association with common cardiovascular risk factors.
Methods and Results—AAA mortality (1994-2010) using ICD codes were extracted from the WHO mortality database and age standardised. WHO InfoBase and International Mortality and Smoking Statistics provided risk factor data. Nineteen WHO member states were included (Europe=14, Australasia=2, North America=2, Asia=1). Regression analysis of temporal trends in cardiovascular risk factors (1946-2010) were analysed independently for correlations to AAA mortality trends. Global AAA mortality trends show substantial heterogeneity with the USA and UK recording the greatest national decline, whilst internationally males and those under 75 demonstrated the greatest reductions. AAA mortality has increased in Hungary, Romania, Austria and Denmark therefore the mortality decline is not universal. A positive linear relationship exists between global trends in systolic blood pressure (P=<0.03), cholesterol (P=<0.03) and smoking prevalence (P=<0.02) in males and females. BMI demonstrated a negative linear association with AAA mortality (P=<0.007) whilst fasting blood glucose showed no association.
Conclusions—AAA mortality has not declined globally and this study reveals that differences between nations can be explained by variations in traditional cardiovascular risk factors. Declines in smoking prevalence correlate most closely with declines in AAA mortality and a novel 'obesity paradox' has been identified which requires further investigation. Public health measures could therefore further reduce global AAA mortality, with greatest benefits in the younger age group.
- Received August 5, 2013.
- Revision received November 4, 2013.
- Accepted November 7, 2013.