Associations between Abdominal Aortic Aneurysm with Cardiovascular Disease and All Cause Death in the Atherosclerosis...

This retrospective cohort study of data from the prospective Atherosclerosis Risk in Communities (ARIC) study sought to better understand the contemporary risk of cardiovascular disease (CVD) in diverse populations with abdominal aortic aneurysm (AAA).

Clinical event follow up data from 1987 - 2021 were obtained for participants in the ARIC study. Clinical AAA diagnosis was ascertained via participant hospitalisation discharge diagnosis ICD-9 and ICD-10 codes, and defined as an ICD-9-CM code of either 441.3 or 441.4, or ICD-10-CM code I71.3 or I71.4. Screening ultrasound detected AAA was defined as an infrarenal aortic diameter measuring ≥ 3 cm. Multivariable Cox regression was used to explore the associations between clinical AAA as a time dependent variable and subsequent risk of myocardial infarction (MI), stroke, and all cause death, after adjusting for potential confounders.

Among 14 219 ARIC cohort participants without AAA at visit 1, 741 experienced incident AAA during a mean of 25.6 (SD 8.8) years of follow up. A total of 1 890 incident MI and 1 473 incident stroke events occurred, along with 8 647 deaths. Of these, 64 MI, 51 stroke events, and 572 deaths occurred within an average of 6.9 (SD 5.9) years following incident AAA. The incidence rates for MI, stroke, and all cause death among participants with AAA were 17.1, 11.8, and 114 per 1 000 person years of follow up. The adjusted hazard ratio (95% CI) for incident MI among participants with AAA, as compared with those free of AAA, was 2.59 (1.34 - 5.03). Adjusted hazard ratios for stroke and all cause death were 1.60 (1.17 - 2.19) and 1.77 (1.58 - 1.99).

In this study, incident AAA was independently associated with future risk of adverse CVD outcomes within a diverse population over an extended follow up period. These results add urgency to recommendations for cardiovascular risk factor management among patients with a diagnosis of AAA.