Waterhouse D F, Cahill R A, Sheehan F, Sheehan S J
Department of Vascular Medicine, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
World J Surg. 2006 Jul;30(7):1350-9. doi: 10.1007/s00268-005-0604-x.
Although population screening for abdominal aortic aneurysm (AAA) has/had a significant impact on disease-specific mortality, coexisting systemic atherosclerosis represents the major impediment to improved longevity. We examined the feasibility and yield of full cardiovascular assessment concomitant with screening for AAA detection.
A total of 1032 asymptomatic men over the age of 50 years (328 were >60 years) underwent a detailed cardiac health questionnaire, sphygmomanometry, body mass index calculation, fasting lipid profiling, ultrasonographic (US) examination of their infrarenal aorta and carotid arteries, and treadmill exercise stress testing. Framingham and SCORE project estimations of the 10-year risk of ischemic heart disease (IHD) and fatal cardiovascular disease (CVD) of any cause were calculated for the men with an AAA and in those>60 years but with neither AAA nor known cardiac disease.
Overall, we detected an AAA>3 cm in 30 men (2.9%). Unaddressed obesity, smoking, hypertension, impaired glucose metabolism, and hypercholesterolemia were commonly identified in individuals both with and without an AAA, being notably frequent in those>60 years without an AAA. The 10-year risk of IHD and CHD in those>60 years was similar regardless of whether an AAA was present. Doppler screening for significant carotid stenosis had detection rates similar to those for aortic US scanning, being most useful in those>65 years of age. Exercise stress testing, however, was of only limited value when used nonselectively.
Modifiable atherosclerotic disease and cardiovascular risk can be readily detected in individuals presenting for AAA screening and are present to a significant degree at an earlier age. Consideration of selected, additional investigations is required to maximize the value of generalized screening programs.
尽管对腹主动脉瘤（AAA）进行人群筛查对疾病特异性死亡率产生了重大影响，但并存的全身性动脉粥样硬化仍是延长寿命的主要障碍。我们研究了在筛查AAA时同时进行全面心血管评估的可行性和收益。
共有1032名50岁以上的无症状男性（328名年龄大于60岁）接受了详细的心脏健康问卷调查、血压测量、体重指数计算、空腹血脂分析、肾下腹主动脉和颈动脉的超声（US）检查以及跑步机运动压力测试。计算了患有AAA的男性以及年龄大于60岁但既无AAA也无已知心脏病的男性患缺血性心脏病（IHD）和任何原因导致的致命心血管疾病（CVD）的10年风险，采用弗明汉和SCORE项目估算方法。
总体而言，我们在30名男性（2.9%）中检测到AAA大于3 cm。无论有无AAA，未解决的肥胖、吸烟、高血压、糖代谢受损和高胆固醇血症在个体中都很常见，在年龄大于60岁且无AAA的人群中尤为频繁。年龄大于60岁的人群中，无论是否存在AAA，其IHD和CHD的10年风险相似。对严重颈动脉狭窄的多普勒筛查检测率与主动脉US扫描相似，在65岁以上人群中最有用。然而，非选择性使用运动压力测试的价值有限。
在接受AAA筛查的个体中，可轻易检测到可改变的动脉粥样硬化疾病和心血管风险，且在较早年龄就已达到显著程度。需要考虑进行特定的额外检查，以最大限度地提高全面筛查项目的价值。
