title: Smoking, sex, risk factors and abdominal aortic aneurysms: a prospective study of 18 782 persons aged above 65 years in the Southern Community Cohort Study.
abstract: BACKGROUND
  Abdominal aortic aneurysm (AAA) is a leading cause of death in the USA. We evaluated the incidence and predictors of AAA in a prospectively followed cohort.
  
  
  METHODS
  We calculated age-adjusted AAA incidence rates (IR) among 18 782 participants aged ≥65 years in the Southern Community Cohort Study who received Medicare coverage from 1999-2012, and assessed predictors of AAA using multivariable Cox proportional hazards models, overall and stratified by sex, adjusting for demographic, lifestyle, socioeconomic, medical and other factors. HRs and 95% CIs were calculated for AAA in relation to factors ascertained at enrolment.
  
  
  RESULTS
  Over a median follow-up of 4.94 years, 281 cases were identified. Annual IR was 153/100,000, 401, 354 and 174 among blacks, whites, men and women, respectively. AAA risk was lower among women (HR 0.48, 95% CI 0.36 to 0.65) and blacks (HR 0.51, 95% CI 0.37 to 0.69). Smoking was the strongest risk factor (former: HR 1.91, 95% CI 1.27 to 2.87; current: HR 5.55, 95% CI 3.67 to 8.40), and pronounced in women (former: HR 3.4, 95% CI 1.83 to 6.31; current: HR 9.17, 95% CI 4.95 to 17). A history of hypertension (HR 1.44, 95% CI 1.04 to 2.01) and myocardial infarction or coronary artery bypass surgery (HR 1.9, 95% CI 1.37 to 2.63) was negatively associated, whereas a body mass index ≥25 kg/m(2) (HR 0.72; 95% CI 0.53 to 0.98) was protective. College education (HR 0.6, 95% CI 0.37 to 0.97) and black race (HR 0.44, 95% CI 0.28 to 0.67) were protective among men.
  
  
  CONCLUSIONS
  Smoking is a major risk factor for incident AAA, with a strong and similar association between men and women. Further studies are needed to evaluate benefits of ultrasound screening for AAA among women smokers.
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA John Ochsner Heart and Vascular Institute, Ochsner Clinical School- The University of Queensland School of Medicine, New Orleans, Louisiana, USA.
authors.forename: Eiman
authors.initials: E
authors.lastname: Jahangir
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Loren
authors.initials: L
authors.lastname: Lipworth
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Todd L
authors.initials: TL
authors.lastname: Edwards
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Edmond K
authors.initials: EK
authors.lastname: Kabagambe
authors.affiliation: International Epidemiology Institute, Rockville, Maryland, USA.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Mumma
authors.affiliation: National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: George A
authors.initials: GA
authors.lastname: Mensah
authors.affiliation: Center of Preventive Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: Sergio
authors.initials: S
authors.lastname: Fazio
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA International Epidemiology Institute, Rockville, Maryland, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Blot
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Uchechukwu K A
authors.initials: UK
authors.lastname: Sampson
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology* / Q000208:ethnology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D065840:Protective Factors; D018570:Risk Assessment; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology*; D012959:Socioeconomic Factors; D015144:Southeastern United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
keywords: EPIDEMIOLOGY; Epidemiology of cardiovascular disease; SMOKING; VASCULAR DISEASE