title: Meta-analysis of individual patient data to examine factors affecting growth and rupture of small abdominal aortic aneurysms.
abstract: BACKGROUND
  Surveillance is a common management strategy for small abdominal aortic aneurysm (AAA) (3.0-5.4 cm in diameter). Individual characteristics, other than diameter, may influence aneurysm growth or rupture rates.
  
  
  METHODS
  Individual data were collated from 15 475 people under follow-up for a small aneurysm in 18 studies. The influence of co-variables (including demographics, medical and drug history) on aneurysm growth and rupture rates (analysed using longitudinal random-effects modelling and survival analysis with adjustment for aneurysm diameter) were summarized in an individual patient meta-analysis.
  
  
  RESULTS
  The mean aneurysm growth rate of 2.21 mm/year was independent of age and sex. Growth rate was increased in smokers (by 0.35 mm/year) and decreased in patients with diabetes (by 0.51 mm/year). Mean arterial pressure had no effect and antihypertensive or other cardioprotective medications had only small, non-significant effects on aneurysm growth, consistent with the observation that calendar year of enrollment was not associated with growth rate. Rupture rates were almost fourfold higher in women than men (P < 0.001), were double in current smokers (P = 0.001) and increased with higher blood pressure (P = 0.001).
  
  
  CONCLUSIONS
  Follow-up schedules for individuals with a small AAA may need to consider diabetes and smoking, in addition to aneurysm diameter. The differing risk factors for growth and rupture suggest that a lower threshold for surgical intervention in women may be justified. No single drug used for cardiovascular risk reduction had a major effect on the growth or rupture of small aneurysms.
authors.affiliation: MRC Biostatistics Unit, Institute of Public Health, London, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Sweeting
authors.forename: S G
authors.initials: SG
authors.lastname: Thompson
authors.forename: L C
authors.initials: LC
authors.lastname: Brown
authors.forename: J T
authors.initials: JT
authors.lastname: Powell
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology / Q000473:pathology*; D001019:Aortic Rupture / Q000453:epidemiology / Q000473:pathology*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003920:Diabetes Mellitus / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000473:pathology
chemical_list: D002317:Cardiovascular Agents