title: Systematic review of cardiovascular disease and cardiovascular death in patients with a small abdominal aortic aneurysm.
abstract: BACKGROUND
  Screening for abdominal aortic aneurysm (AAA) has reduced the rate of AAA rupture. However, cardiovascular disease is still a major cause of death in men with an AAA. The aim of this study was to assess cardiovascular risk in patients with a small AAA.
  
  
  METHODS
  Standard PRISMA guidelines were followed. Analysis was performed of studies reporting cardiovascular outcomes in patients with a small AAA (30-54 mm). Weighted metaregression was performed for cardiovascular death in patients with a small AAA, and the prevalence of cardiovascular disease was reviewed.
  
  
  RESULTS
  Twenty-one articles were identified describing patients with an AAA, and the prevalence of, and death from, cardiovascular disease. Ten of these reported cardiovascular death rates in patients with a small AAA. Some 2323 patients with a small AAA were identified; 335 cardiovascular deaths occurred, of which 37 were due to AAA rupture. Metaregression demonstrated that the risk of cardiovascular death was 3·0 (95 per cent c.i. 1·7 to 4·3) per cent per year in patients with a small AAA (R(2) = 0·902, P < 0·001). The prevalence of ischaemic heart disease (44·9 per cent), myocardial infarction (26·8 per cent), heart failure (4·4 per cent) and stroke (14·0 per cent) was also high in these patients.
  
  
  CONCLUSIONS
  The risk of cardiovascular death in patients with a small AAA is high and increases by approximately 3 per cent each year after diagnosis. Patients with a small AAA have a high prevalence of cardiovascular disease. Patients a small AAA should be considered for lifestyle modifications and secondary cardiovascular protection.
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
authors.forename: M F
authors.initials: MF
authors.lastname: Bath
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
authors.forename: V J
authors.initials: VJ
authors.lastname: Gokani
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
authors.forename: D A
authors.initials: DA
authors.lastname: Sidloff
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
authors.forename: L R
authors.initials: LR
authors.lastname: Jones
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
authors.forename: E
authors.initials: E
authors.lastname: Choke
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
authors.forename: R D
authors.initials: RD
authors.lastname: Sayers
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.|National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Bown
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000150:complications*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D008297:Male; D008403:Mass Screening; D015995:Prevalence; D012307:Risk Factors