The aneurysm detection and management study screening program - Validationcohort and final results

Background: We previously reported the prevalence and associations of abdom inal aortic aneurysm (AAA) in 73 451 veterans aged 50 to 79 years who under went ultrasound screening. Objective: To understand the prevalence of and principal positive and negat ive risk factors fur AAA, and to assess reproducibility of our previous fin dings. Methods: In the new cohort of veterans undergoing screening, 52 745 subject s aged 50 to 79 without history of AAA underwent successful ultrasound scre ening for AAA, after completing a questionnaire on demographics and potenti al risk factors. Results: We detected AAA of 4.0 cm or larger in 613 participants (1.2%, com pared with 1.4% in the earlier cohort). The direction and magnitude of the important associations reported in the first cohort were confirmed. Respect ive odds ratios for the major associations with AAA for the second and for the combined cohorts were as follows: 1.81 and 1.71 for age (per 7 years), 0.12 and 0.18 for female sex, 0.59 and 0.53 for black race, 1.94 and 1.94 f or family history of AAA, 4.45 and 5.07 for smoking, 0.50 and 0.52 for diab etes, and 1.60 and 1.66 for atherosclerotic diseases. The excess prevalence associated with smoking accounted for 75% of all AAAs of 4.0 cm or larger in the total population of 126 196. Associations for AAA of 3.0 to 3.9 cm w ere similar but tended to be somewhat weaker. Conclusions: Our findings confirm our previous cohort findings. Age, smokin g, family history of AAA, and atherosclerotic diseases remained the princip al positive associations with AAA, and female sex, diabetes, and black race remained the principal negative associations.