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

J Epidemiol Community Health. 2015 May;69(5):481-8. doi: 10.1136/jech-2014-204920. Epub 2015 Jan 6.

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.

Keywords: EPIDEMIOLOGY; Epidemiology of cardiovascular disease; SMOKING; VASCULAR DISEASE.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • African Americans / statistics & numerical data
  • Aged
  • Aortic Aneurysm, Abdominal / epidemiology*
  • Aortic Aneurysm, Abdominal / ethnology
  • Cardiovascular Diseases / epidemiology
  • Comorbidity
  • Diabetes Mellitus / epidemiology
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Humans
  • Incidence
  • Life Style*
  • Male
  • Middle Aged
  • Prevalence
  • Proportional Hazards Models
  • Prospective Studies
  • Protective Factors
  • Risk Assessment
  • Sex Distribution
  • Smoking / epidemiology*
  • Socioeconomic Factors
  • Southeastern United States / epidemiology