Lower atherosclerotic burden in familial abdominal aortic aneurysm.
OBJECTIVE
Despite the apparent familial tendency toward abdominal aortic aneurysm (AAA) formation, the genetic causes and underlying molecular mechanisms are still undefined. In this study, we investigated the association between familial AAA (fAAA) and atherosclerosis.


METHODS
Data were collected from a prospective database including AAA patients between 2004 and 2012 in the Erasmus University Medical Center, Rotterdam, The Netherlands. Family history was obtained by written questionnaire (93.1% response rate). Patients were classified as fAAA when at least one affected first-degree relative with an aortic aneurysm was reported. Patients without an affected first-degree relative were classified as sporadic AAA (spAAA). A standardized ultrasound measurement of the common carotid intima-media thickness (CIMT), a marker for generalized atherosclerosis, was routinely performed and patients' clinical characteristics (demographics, aneurysm characteristics, cardiovascular comorbidities and risk factors, and medication use) were recorded. Multivariable linear regression analyses were used to assess the mean adjusted difference in CIMT and multivariable logistic regression analysis was used to calculate associations of increased CIMT and clinical characteristics between fAAA and spAAA.


RESULTS
A total of 461 AAA patients (85% men, mean age, 70 years) were included in the study; 103 patients (22.3%) were classified as fAAA and 358 patients (77.7%) as spAAA. The mean (standard deviation) CIMT in patients with fAAA was 0.89 (0.24) mm and 1.00 (0.29) mm in patients with spAAA (P = .001). Adjustment for clinical characteristics showed a mean difference in CIMT of 0.09 mm (95% confidence interval, 0.02-0.15; P = .011) between both groups. Increased CIMT, smoking, hypertension, and diabetes mellitus were all less associated with fAAA compared with spAAA.


CONCLUSIONS
The current study shows a lower atherosclerotic burden, as reflected by a lower CIMT, in patients with fAAA compared with patients with spAAA, independent of common atherosclerotic risk factors. These results support the hypothesis that although atherosclerosis is a common underlying feature in patients with aneurysms, atherosclerosis is not the primary driving factor in the development of fAAA.
Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands.
Koen M
KM
van de Luijtgaarden
Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Angiology and Vascular Surgery, Hospital de Santa Marta, CHLC, Lisbon, Portugal.
Frederico
F
Bastos Gonçalves
Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Sanne E
SE
Hoeks
Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Tabita M
TM
Valentijn
Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Robert J
RJ
Stolker
Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands.
Danielle
D
Majoor-Krakauer
Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: h.verhagen@erasmusmc.nl.
Hence J M
HJ
Verhagen
Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Ellen V
EV
Rouwet
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology / Q000235:genetics*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000235:genetics*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D059168:Carotid Intima-Media Thickness; D016009:Chi-Square Distribution; D005260:Female; D020022:Genetic Predisposition to Disease; D040941:Heredity; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D010641:Phenotype; D058226:Plaque, Atherosclerotic; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires