Targeted Screening Projected To Reduce Deaths From Abdominal Aortic Aneurysms

Dr. Dominic PJ Howard BM BCh MA DPhil (Oxon) MRCS Vascular and Endovascular Fellow Flinders Medical Centre Southern Adelaide Local Health NetworkMedicalResearch.com Interview with:
Dr. Dominic PJ Howard BM BCh MA DPhil (Oxon) MRCS
Vascular and Endovascular Fellow
Flinders Medical Centre
Southern Adelaide Local Health Network

Dr. Howard is I academic vascular surgeon currently based in Oxford, UK. He worked with Professor Peter Rothwell as part of the Oxford Vascular Study.

 

Medical Research: What is the background for this study? What are the main findings?

Dr. Howard: Abdominal aortic aneurysm is a potentially lethal ballooning of the aorta, the body’s largest blood vessel, which supplies blood from the heart to the abdomen and on to the rest of the body. Smoking, high blood pressure, male gender and older age are four key risk factors for abdominal aneurysms. Currently, men 65 and older are screened in the United States and in Europe for the condition based on recommendations from European screening trials and the U.S. Preventive Services Task Force. However, deaths from abdominal aortic aneurysm are moving to older ages.

Our study is the first prospective population-based study of ruptured abdominal aortic aneurysm events.  We have found high incidence and death rates for this condition, particularly in older people. Most ruptured aortic aneurysms currently happen in people aged over 75 and this is likely to shift to those aged over 85 during the next few decades. The few ruptured aortic aneurysms that do occur in younger people (aged 65-75) occur almost exclusively in male smokers. Therefore we have calculated that if the national UK screening policy was modified to screen only male current smokers aged 65 and then all men at age 75 this could result in an almost four-fold increase in the number of deaths prevented and a three-fold increase in the number of life-years saved compared to the current UK strategy, with about a 20% reduction in the number of scans required.

MedicalResearch: How do you assess the major risk factors of smoking and high  blood pressure for AAA?

Dr. Howard: In our study, we studied people with  ruptured aortic aneurysm, including those who currently smoke, compared to those who have ever smoked, and those who have never smoked. We also looked at people with diagnosed hypertension and investigated how well individual patient blood pressure was controlled in the 15 year period prior to them developing an aortic aneurysm. We found that more can be done to tightly control the blood pressure of people at risk of developing aortic aneurysms.

MedicalResearch: Why are nearly two-thirds of all acute AAA older than 75 years?  Do you see other medical conditions being first seen at older ages?

Dr. Howard: Aortic aneurysm formation is a degenerative condition affecting the wall of this major artery and normally the balloon-like expansion occurs in the abdomen just above the level of the umbilicus. As with many degenerative conditions, as one gets older there is an increased risk of developing the condition. As the number of people living over the age of 75 has more than doubled in the last 2 decades, the majority of people suffering ruptured aortic aneurysms are now over 75. Other conditions that will become more and more common, as the aging population continues, are peripheral arterial disease (affecting the blood supply to the legs) and dementia (a degenerative condition affecting brain function). There is a huge amount of research opportunity for both of these conditions also.

MedicalResearch: What is your major message to the general public in regard to screening of abdominal aortic aneurysm?

Dr. Howard: The current screening programmes in the UK, Europe and US are a major  step-forward in treating this condition. However, these strategies need to adaptive to the changing population that they serve. As people age and smoking rates decrease, strategies will need to be modified in order to stay effective. We have provided evidence supporting modification of the UK NHS screening programme.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Howard: Although screening has not previously been shown to be beneficial in women, we have found that over a quarter of acute events currently occur in women and this proportion is likely rise to a third by 2030. So consideration should be given to offering screening to women with risk factors and a policy of screening all women aged 75 with known hypertension could be evaluated in randomised trials.

MedicalResearch: What is your own next step in research?

Dr. Howard: The Oxford Vascular Study also involves similar epidemiological research looking at peripheral arterial disease. This condition affects over 200 million people worldwide and much more can be done to prevent people developing life and limb threatening blood flow problems in arteries that supply the limbs and major organs.

Citation:

Dominic P. J. Howard, Amitava Banerjee, Jack F. Fairhead, Ashok Handa, Louise E. Silver, Peter M. Rothwell, and the Oxford Vascular Study.Population‐Based Study of Incidence of Acute Abdominal Aortic Aneurysms With Projected Impact of Screening Strategy. JAHA, August 2015 DOI: 10.1161/JAHA.115.001926

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Dominic PJ Howard (2015). Targeted Screening Projected To Reduce Deaths From Abdominal Aortic Aneurysms