Simple adaptation of current abdominal aortic aneurysm screening programs may address all-cause cardiovascular mortality: prospective observational cohort study.
BACKGROUND
Population screening for abdominal aortic aneurysm (AAA) can be cost-justified by its impact on the incidence of emergency presentations with rupture. The objective of this prospective, cohort study was to determine whether the proposed framework can be further evolved to address all-cause cardiovascular mortality in the community by integrating full risk factor assessment.


METHODS
Male volunteers aged >60 years attending for AAA screening by ultrasound also underwent full cardiovascular assessment via physician-administered health questionnaire, sphygmomanometry, anthromorphometry, and fasting phlebotomy for lipid and glucose profiling. Framingham and SCORE project evaluations were used to calculate 10-year risk of ischemic heart disease and all-cause fatal cardiovascular disease, respectively.


RESULTS
A total of 481 men were screened, and 23 (4.8%) had an AAA detected (22% of which were >4 cm). Obesity, smoking, hypertension, impaired glucose metabolism, and hypercholesterolemia were notably frequent in those without an AAA. Mean 10-year cardiovascular risk in the population without AAA (6.89 and 6.74 by SCORE and Framingham estimations, respectively) was similar to those with AAA (7.78 and 7.04, respectively). Supplementary screening increased total costs by 2.5%. Reserving concomitant atherosclerotic testing for those with elevated systolic blood pressure at presentation allowed identification of 96%/95% of those with Framingham/SCORE risks >10%, respectively, thus saving 162 (33%) individuals from additional investigation and conserving the cost increment to 1.8% overall.


CONCLUSIONS
The proven framework of population sifting for AAA provides a unique opportunity to also confront latent cardiovascular malady. Sphygmomanometry during ultrasonographic screening for AAA seems both cost-effective and readily incorporated within the current paradigm.
Waterhouse
Deirdre F
DF
Department of Preventative Health, Blackrock Clinic, Dublin, Ireland.
Cahill
Ronan A
RA
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000401:mortality*; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014463:Ultrasonography