title: Risk factors associated with the diagnosis of abdominal aortic aneurysm in patients screened at a regional Veterans Affairs health care system.
abstract: BACKGROUND
  An active abdominal aortic aneurysm (AAA) screening program at a regional Veterans Affairs (VA) health system identifies patients at risk for AAA. The purpose of this study is to evaluate unique risk factors associated with the AAA diagnosis upon AAA screening examination to identify the most at risk patients for AAA.
  
  
  METHODS
  Data were extracted from a regional VA health care system to identify patients who underwent AAA screening within a 3-year period. An aortic diameter ≥3.0 cm was defined as an AAA. Patient risk factors included age, body mass index, total cholesterol, estimated glomerular filtration rate (eGFR), statin use, and active smoking status; the presence of hypertension, diabetes, coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), or peripheral vascular disease (PVD) was also evaluated. Risk factors were compared in a multivariate analysis between patients with AAA and patients with a normal aorta.
  
  
  RESULTS
  A total of 6,142 patients (mean ± SD age: 72.7 ± 5.3 years) were screened for AAA between January 2007 and December 2009. A total of 469 patients (7.6%) with AAA were identified. The following risk factors were significantly associated with a diagnosis of AAA: age >75 years (39.6% vs. 28.9%; P < 0.001), prevalence of CAD (43.1% vs. 28.5%; P < 0.001), COPD (26% vs. 11.4%; P < 0.001), PVD (37.3% vs. 7.7%; P < 0.001), eGFR <60 mL/min (36.7% vs. 24.3%; P < 0.001), and current smoking (23.2% vs. 15.3%; P < 0.001). The risk factors significantly associated with normal aortic size were the presence of diabetes (18.6% vs. 27.4%; P < 0.001) and total cholesterol ≥200 mg/dL (10.4% vs. 15%; P = 0.04).
  
  
  CONCLUSIONS
  The diagnosis of AAA in a large screening study is typically identified in patients who are at high risk for cardiovascular disease. The presence of diabetes is a major cardiovascular risk factor that is more associated with normal aorta when compared to patients with the AAA diagnosis. Total cholesterol ≥200 mg/dL was associated with decreased AAA risk, and renal insufficiency was associated with increased AAA risk.
authors.affiliation: Department of Surgery, Sacramento Veterans Affairs Medical Center, Mather, CA.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chun
authors.affiliation: Department of Surgery, Sacramento Veterans Affairs Medical Center, Mather, CA.
authors.forename: Kai Y
authors.initials: KY
authors.lastname: Teng
authors.affiliation: Department of Surgery, University of California-Davis, Sacramento, CA.
authors.forename: LeAnn A
authors.initials: LA
authors.lastname: Chavez
authors.affiliation: Department of Surgery, Sacramento Veterans Affairs Medical Center, Mather, CA.
authors.forename: Elyse N
authors.initials: EN
authors.lastname: Van Spyk
authors.affiliation: Department of Surgery, Sacramento Veterans Affairs Medical Center, Mather, CA.
authors.forename: Kiana M
authors.initials: KM
authors.lastname: Samadzadeh
authors.affiliation: Department of Surgery, Sacramento Veterans Affairs Medical Center, Mather, CA; Department of Surgery, University of California-Davis, Sacramento, CA.
authors.forename: John G
authors.initials: JG
authors.lastname: Carson
authors.affiliation: Department of Surgery, Sacramento Veterans Affairs Medical Center, Mather, CA; Department of Surgery, University of California-Davis, Sacramento, CA. Electronic address: Eugenes.lee@ucdmc.ucdavis.edu.
authors.forename: Eugene S
authors.initials: ES
authors.lastname: Lee
mesh_terms: D000367:Age Factors; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis* / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008403:Mass Screening; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D051437:Renal Insufficiency / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D058014:Veterans Health