Abdominal aortic aneurysms (AAA) are responsible for 15,000 fatalities annually in the USA and are the 10th leading cause of death. Approximately 5-7% of adults over 60 years old are affected by AAA. Although it appears to be twice as common in men than in women, the risk of risk of rupture in women is actually four-fold that in men. When an AAA ruptures, it carries a 75-90% mortality rate. Moreover, women appear to rupture at smaller sizes aneurysms and have a worse outcome than men with ruptured AAA.
While only 2-3% of women appear to be affected by AAA, age, smoking, and heart disease are each associated with increased risk of AAA in women. When all three risk factors are present together, the incidence of AAA is as high as 7%. Smoking has been shown to be the single most important risk factor for women who develop AAA. Other risk factors include hypertension, high cholesterol, obstructive pulmonary disease, and family history of AAA.
Some hypothesize that AAA presents later in women because of the known cardioprotective effect of Estrogen in pre-menopausal women. This is somewhat controversial as estrogen replacement has not been shown to prevent AAA from occurring.
There is a known genetic predisposition for AAA formation. First degree relatives are at increased risk. Anyone, male or female, with a sibling who has an AAA has a 5-fold risk of developing an aneurysm compared to the general population and should be screened for AAA with ultrasound, a non-invasive test.
People who are at risk for AAA need to be screened with a simple non-invasive test known as an ultrasound or sonogram. This should be done at age 60 in men and perhaps age 65 in women. Any AAA, regardless of size needs to be closely followed and AAA of 4.5-5.0cm in women and 5.0-5.5cm in men should be repaired to avoid rupture. If diagnosed with an AAA one should make all attempts to modify risk factors (i.e. smoking cessation, control high blood pressure and other cardiovascular disease, reduce cholesterol).
Thomas Maldonado, Associate Professor of Surgery at NYU School of Medicine and Chief of Vascular Surgery at Bellevue Hospital.
Submit a guest post and be heard.
