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Does the Mediterranean paradox extend to abdominal aortic aneurysm?
K Jamrozik1, C A Spencer, M M Lawrence-Brown
1Department of Public Health, The University of Western Australia, Nedlands, Western Australia. konrad@ic.ac.uk
International Journal of Epidemiology
|November 2, 2001
Summary
Abdominal aortic aneurysm (AAA) prevalence varied by country of birth in Australian men. Height adjustment reduced, but did not eliminate, AAA prevalence differences, suggesting complex risk factors beyond simple diet.
Area of Science:
- Vascular Surgery
- Epidemiology
- Public Health
Background:
- Clinical observations suggest differing abdominal aortic aneurysm (AAA) prevalence among migrant groups.
- Specific hypotheses propose higher AAA rates in Dutch migrants and lower rates in Mediterranean migrants.
Purpose of the Study:
- To investigate the prevalence of abdominal aortic aneurysms (AAA) in men undergoing ultrasound screening in Western Australia.
- To examine the association between country of birth and AAA prevalence, considering factors like smoking and alcohol consumption.
Main Methods:
- Population-based ultrasound screening for AAA involving 12,203 men.
- Questionnaires collected data on place of birth, smoking, alcohol, and dietary habits.
- Analysis of infrarenal aortic diameter and AAA prevalence (≥30 mm, ≥50 mm, 95th/99th centiles) stratified by country of birth and adjusted for height.
Main Results:
- AAA prevalence was higher in men from The Netherlands and Scotland, associated with higher smoking rates.
- Lower AAA prevalence was observed in men of Mediterranean origin, linked to higher alcohol consumption.
- Height adjustment reduced AAA prevalence disparities, but a threefold variation persisted for AAA exceeding the 95th percentile of height-adjusted diameter.
Conclusions:
- While country of birth influences AAA prevalence, the 'Mediterranean paradox' for AAA appears less pronounced than for coronary heart disease.
- Factors beyond simple dietary data, potentially including 'healthy migrant' and 'survivor' effects, contribute to observed variations in AAA prevalence.