Cardiovascular disease and mortality in older adults with small abdominal aortic aneurysms detected by ultrasonography: The cardiovascular health study

Background: Persons with abdominal aortic aneurysm are more likely to have a higher prevalence of risk factors for and clinical manifestations of card iovascular disease. It is unknown whether these factors explain the high mo rtality rate associated with abdominal aortic aneurysm. Objective: To describe the risk for mortality, cardiovascular mortality, an d cardiovascular morbidity in persons screened for abdominal aortic aneurys m. Design: Longitudinal cohort study. Setting: Four communities in the United States. Participants: 4734 men and women older than 65 years of age recruited from Medicare eligibility lists. Measurements: Abdominal ultrasonography was used to measure the aortic diam eter and the ratio of infrarenal to suprarenal measurement of aortic diamet er in 1992-1993. Abdominal aortic aneurysm was defined as aortic diameter o f 3 cm or greater or infrarenal-to-suprarenal ratio of 1.2 or greater. Mort ality, cardiovascular disease mortality, incident cardiovascular disease, a nd repair or rupture were assessed after 4.5 years. Results: The prevalence of aneurysm was 8.8%, and 87.7% of aneurysms were 3 .5 cm or less in diameter, Rates of total mortality (65.1 vs. 32.8 per 1000 person-years), cardiovascular mortality (34.3 vs. 13.8 per 1000 person-yea rs), and incident cardiovascular disease (47.3 vs. 31.0 per 1000 person-yea rs) were higher in participants with aneurysm than in those without aneurys m; after adjustment for age, risk factors, and presence of other cardiovasc ular disease, the respective relative risks were 1.32, 1.36, and 1.57. Rate s of repair and rupture were low. Conclusions: Rates of total mortality, cardiovascular disease mortality, an d incident cardiovascular disease were higher in participants with abdomina l aortic aneurysm than in those without aneurysm, independent of age, sex, other clinical cardiovascular disease, and extent of atherosclerosis detect ed by noninvasive testing. Persons with smaller aneurysms detected by ultra sonography should be advised to modify risk factors for cardiovascular dise ase while under surveillance for increase in the size of the aneurysm.