Meta-analysis of individual patient data to examine factors affecting growth and rupture of small abdominal aortic aneurysms

M J Sweeting; S G Thompson; L C Brown; J T Powell

doi:10.1002/bjs.8707

journal article Mar 05, 2012

Meta-analysis of individual patient data to examine factors affecting growth and rupture of small abdominal aortic aneurysms

M J Sweeting S G Thompson L C Brown J T Powell

British Journal of Surgery Vol. 99 No. 5 pp. 655-665 · Oxford University Press (OUP)

View at Publisher Save 10.1002/bjs.8707

Abstract

Abstract

Background
Surveillance is a common management strategy for small abdominal aortic aneurysm (AAA) (3·0–5·4 cm in diameter). Individual characteristics, other than diameter, may influence aneurysm growth or rupture rates.

Methods
Individual data were collated from 15 475 people under follow-up for a small aneurysm in 18 studies. The influence of co-variables (including demographics, medical and drug history) on aneurysm growth and rupture rates (analysed using longitudinal random-effects modelling and survival analysis with adjustment for aneurysm diameter) were summarized in an individual patient meta-analysis.

Results
The mean aneurysm growth rate of 2·21 mm/year was independent of age and sex. Growth rate was increased in smokers (by 0·35 mm/year) and decreased in patients with diabetes (by 0·51 mm/year). Mean arterial pressure had no effect and antihypertensive or other cardioprotective medications had only small, non-significant effects on aneurysm growth, consistent with the observation that calendar year of enrolment was not associated with growth rate. Rupture rates were almost fourfold higher in women than men (P &lt; 0·001), were double in current smokers (P = 0·001) and increased with higher blood pressure (P = 0·001).

Conclusion
Follow-up schedules for individuals with a small AAA may need to consider diabetes and smoking, in addition to aneurysm diameter. The differing risk factors for growth and rupture suggest that a lower threshold for surgical intervention in women may be justified. No single drug used for cardiovascular risk reduction had a major effect on the growth or rupture of small aneurysms.

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References

38

[1]

Fleming "Screening for abdominal aortic aneurysm: a best-evidence systematic review for the U.S. Preventive Services Task Force" Ann Intern Med (2005) 10.7326/0003-4819-142-3-200502010-00012

[2]

Cosford "Screening for abdominal aortic aneurysm" Cochrane Database Syst Rev (2007)

[3]

Filardo "Surgery for small asymptomatic abdominal aortic aneurysms" Cochrane Database Syst Rev (2012)

[4]

Ouriel "Endovascular repair compared with surveillance for patients with small abdominal aortic aneurysms" J Vasc Surg (2010) 10.1016/j.jvs.2009.10.113

[5]

Cao "Comparison of surveillance versus aortic endografting for small aneurysm repair (CAESAR): results from a randomised trial" Eur J Vasc Endovasc Surg (2011) 10.1016/j.ejvs.2010.08.026

[6]

Guessous "The efficacy of pharmacotherapy for decreasing the expansion rate of abdominal aortic aneurysms: a systematic review and meta-analysis" PLoS ONE (2008) 10.1371/journal.pone.0001895

[7]

Bergqvist "Pharmacological interventions to attenuate the expansion of abdominal aortic aneurysm (AAA)—a systematic review" Eur J Vasc Endovasc Surg (2011) 10.1016/j.ejvs.2011.01.009

[8]

Powell "Systematic review and meta-analysis of growth rates of small abdominal aortic aneurysms" Br J Surg (2011) 10.1002/bjs.7465

[9]

Hackam "Angiotensin-converting enzyme inhibitors and aortic rupture: a population-based case–control study" Lancet (2006) 10.1016/s0140-6736(06)69250-7

[10]

Brady "Abdominal aortic aneurysm expansion: risk factors and time intervals for surveillance" Circulation (2004) 10.1161/01.cir.0000133279.07468.9f

[11]

Lederle "Immediate repair compared with surveillance of small abdominal aortic aneurysms" N Engl J Med (2002) 10.1056/nejmoa012573

[12]

Brown "The risk of rupture in untreated aneurysms: the impact of size, gender, and expansion rate" J Vasc Surg (2003) 10.1067/mva.2003.119

[13]

Santilli "Expansion rates and outcomes for the 3·0-cm to the 3·9-cm infrarenal abdominal aortic aneurysm" J Vasc Surg (2002) 10.1067/mva.2002.121572

[14]

Schlosser "Growth predictors and prognosis of small abdominal aortic aneurysms" J Vasc Surg (2008) 10.1016/j.jvs.2008.01.041

[15]

Schouten "Statins are associated with a reduced infrarenal abdominal aortic aneurysm growth" Eur J Vasc Endovasc Surg (2006) 10.1016/j.ejvs.2005.12.024

[16]

Sweeting "Joint modelling of longitudinal and time-to-event data with application to abdominal aortic aneurysm growth and rupture" Biom J (2011) 10.1002/bimj.201100052

[17]

Sweeting "Making predictions from complex longitudinal data, with application to planning monitoring intervals in a national screening programme" J R Stat Soc Ser A Stat Soc (2011)

[18]

Meta-analysis in clinical trials

Rebecca DerSimonian, Nan Laird

Controlled Clinical Trials 1986 10.1016/0197-2456(86)90046-2

[19]

Measuring inconsistency in meta-analyses

Julian P T Higgins, Simon G Thompson, Jonathan J Deeks et al.

BMJ 2003 10.1136/bmj.327.7414.557

[20]

Norman "Population based randomised controlled trial on impact of screening on mortality from abdominal aortic aneurysm" BMJ (2004) 10.1136/bmj.38272.478438.55

[21]

Ashton "Fifteen-year follow-up of a randomized clinical trial of ultrasonographic screening for abdominal aortic aneurysms" Br J Surg (2007) 10.1002/bjs.5780

[22]

Vardulaki "Growth rates and risk of rupture of abdominal aortic aneurysms" Br J Surg (1998) 10.1046/j.1365-2168.1998.00946.x

[23]

Mofidi "Influence of sex on expansion rate of abdominal aortic aneurysms" Br J Surg (2007) 10.1002/bjs.5573

[24]

McCarthy "Recommendations for screening intervals for small aortic aneurysms" Br J Surg (2003) 10.1002/bjs.4216

[25]

Ashton "The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial" Lancet (2002) 10.1016/s0140-6736(02)11522-4

[26]

Solberg "Increased growth rate of abdominal aortic aneurysms in women. The Tromsø study" Eur J Vasc Endovasc Surg (2005) 10.1016/j.ejvs.2004.11.015

[27]

Propranolol Aneurysm Trial Investigators "Propranolol for small abdominal aortic aneurysms: results of a randomized trial" J Vasc Surg (2002) 10.1067/mva.2002.121308

[28]

Vega de Céniga "Growth rate and associated factors in small abdominal aortic aneurysms" Eur J Vasc Endovasc Surg (2006) 10.1016/j.ejvs.2005.10.007

[29]

Karlsson "The effect of azithromycin and Chlamydophilia pneumonia infection on expansion of small abdominal aortic aneurysms—a prospective randomized double-blind trial" J Vasc Surg (2009) 10.1016/j.jvs.2008.12.048

[30]

Lindholt "Screening for abdominal aortic aneurysms: single centre randomised controlled trial" BMJ (2005) 10.1136/bmj.38369.620162.82

[31]

Lederle "Prevalence and associations of abdominal aortic aneurysm detected through screening. Aneurysm Detection and Management (ADAM) Veterans Affairs Cooperative Study Group" Ann Intern Med (1997) 10.7326/0003-4819-126-6-199703150-00004

[32]

Norman "Falling rates of hospitalization and mortality from abdominal aortic aneurysms in Australia" J Vasc Surg (2011) 10.1016/j.jvs.2010.08.087

[33]

Mureebe "National trends in the repair of ruptured abdominal aortic aneurysms" J Vasc Surg (2008) 10.1016/j.jvs.2008.06.031

[34]

Sandiford "Trends in incidence and mortality from abdominal aortic aneurysm in New Zealand" Br J Surg (2011) 10.1002/bjs.7461

[35]

Twine "Systematic review and meta-analysis of the effects of statin therapy on abdominal aortic aneurysms" Br J Surg (2011) 10.1002/bjs.7343

[36]

Sweeting "Use of angiotensin converting enzyme inhibitors is associated with increased growth rate of abdominal aortic aneurysms" J Vasc Surg (2010) 10.1016/j.jvs.2010.02.264

[37]

Lindholt "Impaired results of a randomised double blinded clinical trial of propranolol versus placebo on the expansion rate of small abdominal aortic aneurysms" Int Angiol (1999)

[38]

Powell "Rupture rates of small abdominal aortic aneurysms: a systematic review of the literature" Eur J Vasc Endovasc Surg (2011) 10.1016/j.ejvs.2010.09.005

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Metrics

469

Citations

38

References

Details

Published: Mar 05, 2012
Vol/Issue: 99(5)
Pages: 655-665
License: View

Authors

M

M J Sweeting

MRC Biostatistics Unit, Institute of Public Health, London, UK

S

S G Thompson

Department of Public Health and Primary Case, University of Cambridge, London, UK

L

L C Brown

Vascular Surgery Research Group, Imperial College at Charing Cross, London, UK

J

J T Powell

Vascular Surgery Research Group, Imperial College at Charing Cross, London, UK

Funding

UK National Institute for Health Research Health Technology Assessment Programme

Cite This Article

M J Sweeting, S G Thompson, L C Brown, et al. (2012). Meta-analysis of individual patient data to examine factors affecting growth and rupture of small abdominal aortic aneurysms. British Journal of Surgery, 99(5), 655-665. https://doi.org/10.1002/bjs.8707

Meta-analysis of individual patient data to examine factors affecting growth and rupture of small abdominal aortic aneurysms

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