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Published on: September 8, 2023
Comparison of three targeted approaches to screening for abdominal aortic aneurysm based on cardiovascular risk
G T Jones1, B G Hill1, N Curtis1
1Departments of Surgical Sciences, University of Otago, Dunedin, New Zealand.
Insights
Screening for abdominal aortic aneurysm (AAA) using cardiovascular risk factors identified higher prevalence than in disease-free individuals. This suggests targeted community screening may improve detection in at-risk populations.
Area of Science:
- Vascular Surgery
- Public Health
- Epidemiology
Background:
- Abdominal aortic aneurysm (AAA) poses a significant health burden, yet comprehensive screening programs are scarce.
- Current screening primarily targets men over 65, potentially overlooking other at-risk demographics.
- This study investigates novel screening strategies leveraging cardiovascular disease (CVD) risk assessment.
Purpose of the Study:
- To evaluate the effectiveness of three distinct screening strategies for abdominal aortic aneurysm (AAA) based on cardiovascular risk.
- To compare AAA prevalence across different risk-stratified groups and a control population.
- To identify potential improvements for community-based AAA screening initiatives.
Main Methods:
- Abdominal ultrasound was used to determine AAA prevalence in individuals over 50 undergoing specific cardiovascular assessments.
- Three risk-based screening strategies were employed: coronary angiography, peripheral arterial disease assessment, and community CVD risk assessment.
- A control group of asymptomatic volunteers over 60 with no signs of cardiovascular disease was included for comparison.
Main Results:
- Overall AAA prevalence was 4.4% across the three strategies, significantly higher than the 1.0% in the CVD-free control group.
- Male sex, older age, and smoking were identified as significant risk factors for AAA.
- The community-based CVD risk assessment strategy detected younger individuals with AAA compared to other methods.
Conclusions:
- Cardiovascular risk-based screening strategies yield significantly higher abdominal aortic aneurysm (AAA) detection rates compared to screening in disease-free individuals.
- These findings support the potential for targeted community-based AAA screening, particularly in regions lacking advanced national programs.
- Implementing risk-stratified screening can enhance early detection and management of AAA in diverse populations.
Background:
Abdominal aortic aneurysm (AAA) continues to be a significant health burden yet few countries have implemented a comprehensive screening programme. Screening typically places emphasis on men aged over 65 years; however, there is concern that other at-risk groups may be underidentified. The present study examined three potential screening strategies based on cardiovascular risk.
Methods:
The prevalence of AAA was determined by abdominal ultrasound imaging in over 50-year-olds of either sex undergoing coronary angiography, vascular laboratory assessment of peripheral arterial disease, or community-based cardiovascular disease (CVD) event risk assessment. A fourth group, consisting of volunteers aged over 60 years who had no symptoms or signs of cardiovascular disease, was used as a comparator group.
Results:
A total AAA prevalence of 4·4 per cent was detected across all three strategies (137 of 3142 individuals), compared with 1·0 per cent in the CVD-free group. Male sex, age and smoking were all associated with greater AAA prevalence. Although AAA prevalence was lowest using the community-based strategy, those with an AAA detected were on average 7 years younger than those with AAAs detected with the other two strategies (P < 0·001).
Conclusion:
Different strategies, based on CVD risk, resulted in AAA prevalence rates that were significantly greater than that in CVD-free individuals. This may provide opportunities for a targeted approach to community AAA screening in parts of the world where more sophisticated national screening programmes do not exist.
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