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Screening and repair of AAAs had limited effects on overall mortality
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Aggressive medical treatment of CVD may be a more important priority than screening for or treating smaller abdominal aortic aneurysms.
Citing results from studies from the United Kingdom and United States, Joshua Beckman, MD, a cardiologist at Brigham and Women’s Hospital in Boston, suggested that the screening for and treatment of smaller abdominal aortic aneurysms (AAA), although important, may not be the most important action a physician can perform in those patients.
“I want to emphasize the point that once you find this disease, your job does not stop once the aneurysm is fixed, whether it is through a surgical or endovascular approach,” Beckman said in a presentation.
Beckman cited results from several large studies suggesting that aneurysm-related mortality represented a small proportion of overall mortality across several patient populations. A screening study that included more than 68,000 patients suggested that although aneurysm-related mortality could be reduced by screening for them, there was no effect on overall mortality in the patient population. Results from another study in the U.K. suggested that although aneurysm-related deaths contributed to mortality in those who developed them and that the total mortality attributable to aneurysm-related causes was between 20% and 25%, the leading cause of death in the overall population was in fact attributable to CVD.
Beckman also cited results from the EVAR trial, in which he noted that outcomes at two years in patients with AAA treated with any mechanism of repair were similar. According to statistics he cited in his presentation, ruptured aneurysms accounted for 251 deaths in a patient population of more than 33,800 people, compared with 2,450 from ischemic heart disease and 1,391 deaths attributable to other CV causes.
“My take-home message for the EVAR trial was that aneurysm-related mortality is a very small component of the total mortality,” Beckman said. “This is not to minimize the 4% of death caused by aneurysms, but we need to put it in perspective. When you have somebody in front of you with AAA, you should realize that what you have in front of you is a CV emergency and aggressive medical therapy is required.”
Beckman concluded by noting that patients who develop AAAs are already a high-risk population and should be treated aggressively with medical therapy regardless of AAA size, location or condition.
“Development of AAAs occurs in a population at high risk for atherosclerosis, so it is not a surprise that the populations overlap,” Beckman concluded. “Atherosclerosis causes the vast majority of mortality in this group, and AAA size is a marker of vascular heath in general and not just for aneurysm-related disease.”
For more information:
- Beckman J. AAA: Treating coronary artery disease is more important than screening and treating smaller AAA.