Palazzuoli Alberto, Gallotta Maddalena, Guerrieri Giuseppe, Quatrini Ilaria, Franci Beatrice, Campagna Maria Stella, Neri Eugenio, Benvenuti Antonio, Sassi Carlo, Nuti Ranuccio
Department of Internal Medicine and Metabolic Diseases, University of Siena, Le Scotte Hospital, Viale Bracci I, 53100 Siena, Italy.
Vasc Health Risk Manag. 2008;4(4):877-83. doi: 10.2147/vhrm.s1866.
Abdominal aortic aneurysm (AAA) is considered a manifestation of atherosclerosis, however there are epidemiologic, biochemical, and structural differences between occlusive atherosclerosis and AAA. The pathogenesis of AAA involves several factors, first of all destruction of collagen and elastin in the aortic wall. Classical risk factors may influence the evolution and development of AAA, though no consistent association has been found. Aims of the study were to evaluate associations between risk factors and to establish the prevalence of carotid, peripheral vascular and coronary atherosclerosis in patients with AAA.
We studied 98 patients with AAA (Group 1) awaiting surgery compared with high cardiovascular risk population having two or more risk factors (n=82 Group 2). We evaluated traditional risk factors and we studied by eco-doppler and echocardiography the presence of carotid peripheral and coronaric atherosclerosis in two groups.
We found a higher incidence of AAA in males (p < 0.01). The prevalence of infrarenal AAA was significantly higher than suprarenal AAA (81 vs. 17 p < 0.001). No differences in total cholesterol (199 +/- 20 vs. 197 +/- 25 mg/dl), low-density lipoprotein (142 +/- 16 vs. 140 +/- 18 mg/dl), triglycerides (138 +/- 45 vs. 144 +/- 56 mg/dl), glycemia (119 +/- 15 vs. 122 +/- 20 mg/dl), and fibrinogen (388 +/- 154 vs. 362 +/- 92 mg/dl) were found between groups. We demonstrated significant differences for cigarette smoking (p < 0.002), systolic and diastolic blood pressure (150 +/- 15 vs. 143 +/- 14 mmHg and 88 +/- 6 vs. 85 +/- 7 mmHg, p < 0.0001 and p < 0.05, respectively) and high sensititivity C reactive protein (2.8 +/- 1.3 vs. 1.3 +/- 0.7 mg/dl, p < 0.001). High-density lipoprotein (HDL) cholesterol levels were significant greater in Group 1 than Group 2 (p < 0.003). Subgroups of patients with AAA and luminal thrombus showed higher fibrinogen levels (564 +/- 235 vs. 341 +/- 83 mg/dl, p < 0.001) and lower HDL than in controls (46.6 +/- 6.5 vs. 52.1 +/- 7.8 mg/dl, p < 0.01). We did not find any difference in body mass index, or prevalence of coronary and peripheral atherosclerosis between groups. Conversely, we found higher prevalence of carotid atherosclerosis in Group 2 (9% vs. 25%, p < 0.004).
Our AAA patients had fewer and different risk factors respect to patients with atherosclerosis. Only elevated blood pressure, C reactive protein, and smoking showed a significant association with AAA. Atherosclerosis in other arterial districts did not differ respect to subjects with high cardiovascular risk. Our results confirm the hypothesis that AAA and atherosclerosis are two different pathological entities with different risk profiles.
腹主动脉瘤（AAA）被认为是动脉粥样硬化的一种表现，然而，闭塞性动脉粥样硬化与AAA在流行病学、生化和结构方面存在差异。AAA的发病机制涉及多个因素，首先是主动脉壁中胶原蛋白和弹性蛋白的破坏。经典危险因素可能会影响AAA的演变和发展，尽管尚未发现一致的关联。本研究的目的是评估危险因素之间的关联，并确定AAA患者中颈动脉、外周血管和冠状动脉粥样硬化的患病率。
我们研究了98例等待手术的AAA患者（第1组），并与有两个或更多危险因素的高心血管风险人群（n = 82，第2组）进行比较。我们评估了传统危险因素，并通过超声多普勒和超声心动图研究了两组中颈动脉、外周和冠状动脉粥样硬化的情况。
我们发现男性AAA发病率更高（p < 0.01）。肾下腹主动脉瘤的患病率显著高于肾上腹主动脉瘤（81比17，p < 0.001）。两组之间的总胆固醇（199±20 vs. 197±25 mg/dl）、低密度脂蛋白（142±16 vs. 140±18 mg/dl）、甘油三酯（138±45 vs. 144±56 mg/dl）、血糖（119±15 vs. 122±20 mg/dl）和纤维蛋白原（388±154 vs. 362±92 mg/dl）无差异。我们发现吸烟（p < 0.002）、收缩压和舒张压（150±15 vs. 143±14 mmHg和88±6 vs. 85±7 mmHg，分别为p < 0.0001和p < 0.05）以及高敏C反应蛋白（2.8±1.3 vs. 1.3±0.7 mg/dl，p < 0.001）存在显著差异。第1组的高密度脂蛋白（HDL）胆固醇水平显著高于第2组（p < 0.003）。有AAA和腔内血栓的患者亚组显示纤维蛋白原水平较高（564±235 vs. 341±83 mg/dl，p < 0.001），且HDL低于对照组（46.6±6.5 vs. 52.1±7.8 mg/dl，p < 0.01）。我们未发现两组之间体重指数、冠状动脉和外周动脉粥样硬化患病率有任何差异。相反，我们发现第2组颈动脉粥样硬化患病率更高（9%对25%，p < 0.004）。
与动脉粥样硬化患者相比，我们的AAA患者的危险因素更少且不同。只有血压升高、C反应蛋白和吸烟与AAA有显著关联。其他动脉区域的动脉粥样硬化与高心血管风险受试者相比无差异。我们的结果证实了AAA和动脉粥样硬化是两种具有不同风险特征的不同病理实体这一假设。
