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Epidemiology and risk factors in women with abdominal aortic aneurysm
Caron B. Rockman, MD1, Karan Garg, MD1, Thomas S. Maldonado, MD1, Glenn R. Jacobowitz, MD1, Mark A. Adelman, MD1, K. C. Kent, MD2, Thomas S. Riles, MD1, Jeffrey S. Berger, MD1.
1New York University Medical Center, New York, NY, USA, 2University of Wisconsin, Madison, WI, USA.
Objective: Reported studies of AAA have a paucity of female patients. Thus, risk factors in women with AAA are not well delineated. The goal of this study was to analyze a large cohort of women with AAA.
Methods: A cohort of 3,696,778 subjects who underwent vascular screening was used. AAA was defined as diameter ≥ 3 cm. Comparisons were performed between women with and without AAA, and between men and women with AAA. Multivariate analysis was performed.
Results: AAA was present in 1.8% of men (N=25,665) and 0.3% of women (N=6,846) (p<.001). Women with AAA were more likely than women without AAA to have had a prior MI (11.8% vs 2.4%) or stroke (5% vs 1.6%), a smoking history (71.4% vs 38.5%), hypertension (60.8% vs. 43.9%), hypercholesterolemia (62.4% vs. 50.1%), carotid artery disease (17% vs. 3.4%), PAD (22.9% vs. 3.4%), and to have a family history of AAA (11.3% vs. 2.7%) (p<.001). When compared to men with AAA, women with AAA were less likely to have had a prior MI (11.8% vs 17.2%) or coronary intervention (14.2% vs. 23.5%), to have smoked (71.4% vs. 76.6%), and to be Caucasian (88.3% vs. 93%) (p<.001). Women with AAA were more likely than men with AAA to have hypertension (60.8% vs. 55%), hypercholesterolemia (62.4% vs. 59.6%), age ≥ 70 (65.7% vs. 57.4%), and a family history of MI (19.4% vs. 17%), stroke (13% vs. 9.1%), or AAA (11.3% vs. 7.6%) (p<.001). Women with AAA were also more likely than men with AAA to have carotid artery stenosis (17% vs. 11.9%) and PAD (22.9% vs. 12.2%) (p<.001). In multivariate analysis, the most significant predictors of AAA in women were age ≥70 (OR 5.7), smoking history (OR 4.6), and family history (OR 4.3); in men, they were age ≥70 (OR 3.6) smoking history (OR 2.9) and family history (OR 3.2).
Conclusion: While age, smoking, and a family history of AAA are risk factors in all subjects, the influence of smoking and family history are more considerable in women. Women with AAA have a more substantial family history of atherosclerosis, and are more likely to have other peripheral vascular disease as compared to men with AAA. This information has marked implications for appropriate screening of AAA in specific populations of women.
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