Department of Surgery, Raigmore Hospital, Inverness IV2 3UJ, UK.
BMJ. 2012 May 4;344:e2958. doi: 10.1136/bmj.e2958.
To determine whether there is a relation between aortic diameter and morbidity and mortality in men screened for abdominal aortic aneurysm.
Prospective cohort study.
Highland and Western Isles (a large, sparsely populated area of Scotland).
8146 men aged 65-74.
Morbidity and mortality in relation to presence of abdominal aortic aneurysm and three categories of aortic diameter (≤ 24 mm, 25-29 mm, and ≥ 30 mm).
When screened, 414 men (5.1%) had an aneurysm (diameter ≥ 30 mm), 669 (8.2%) an aortic diameter of 25-29 mm, and 7063 (86.7%) an aortic diameter of ≤ 24 mm. The cohort was followed up for a median of 7.4 (interquartile range 6.9-8.2) years. Mortality was significantly associated with aortic diameter: 512 (7.2%) men in the ≤ 24 mm group died compared with 69 (10.3%) in the 25-29 mm group and 73 (17.6%) in the ≥ 30 mm group. The mortality risk in men with an aneurysm or with an aorta measuring 25-29 mm was significantly higher than in men with an aorta of ≤ 24 mm. The increased mortality risk in the 25-29 mm group was reduced when taking confounders such as smoking and known heart disease into account. After adjustment, compared with men with an aortic diameter of ≤ 24 mm, the risk of hospital admission for cardiovascular disease and chronic obstructive pulmonary disease was significantly higher in men with aneurysm and those with aortas measuring 25-29 mm. Men with an aneurysm also had an increased risk of hospital admission for cerebrovascular disease, atherosclerosis, peripheral arterial disease, and respiratory disease. In men with aortas measuring 25-29 mm, the risk of hospital admission with abdominal aortic aneurysm was significantly higher than in men with an aorta of ≤ 24 mm (adjusted hazard ratio 6.7, 99% confidence interval 3.4 to 13.2) and this increased risk became apparent two years after screening.
Men with abdominal aortic aneurysm and those with aortic diameters measuring 25-29 mm have an increased risk of mortality and subsequent hospital admissions compared with men with an aorta diameter of ≤ 24 mm. Consideration should be given to control of risk factors and to rescreening men with aortas measuring 25-29 mm at index scanning.
确定在接受腹主动脉瘤筛查的男性中，主动脉直径与发病率和死亡率之间是否存在关系。
前瞻性队列研究。
高地和西部群岛（苏格兰一个人口稀少的大片地区）。
8146 名 65-74 岁男性。
与腹主动脉瘤和主动脉直径的三种分类（≤24mm、25-29mm 和≥30mm）相关的发病率和死亡率。
筛查时，414 名男性（5.1%）患有动脉瘤（直径≥30mm），669 名男性（8.2%）主动脉直径为 25-29mm，7063 名男性（86.7%）主动脉直径≤24mm。该队列的中位随访时间为 7.4 年（四分位间距 6.9-8.2）。死亡率与主动脉直径显著相关：≤24mm 组有 512 名（7.2%）男性死亡，25-29mm 组有 69 名（10.3%），≥30mm 组有 73 名（17.6%）。动脉瘤或主动脉直径在 25-29mm 之间的男性的死亡风险明显高于主动脉直径≤24mm 的男性。当考虑到吸烟和已知心脏病等混杂因素时，25-29mm 组的死亡率升高风险降低。调整后，与主动脉直径≤24mm 的男性相比，患有动脉瘤和主动脉直径在 25-29mm 之间的男性因心血管疾病和慢性阻塞性肺疾病住院的风险显著更高。患有动脉瘤的男性因脑血管疾病、动脉粥样硬化、外周动脉疾病和呼吸系统疾病住院的风险也增加。主动脉直径在 25-29mm 之间的男性因腹主动脉瘤住院的风险也显著高于主动脉直径≤24mm 的男性（调整后的危险比 6.7，99%置信区间 3.4 至 13.2），并且这种风险增加在筛查后两年变得明显。
与主动脉直径≤24mm 的男性相比，患有腹主动脉瘤和主动脉直径在 25-29mm 之间的男性的死亡率和随后的住院风险增加。应考虑控制危险因素，并对主动脉直径在 25-29mm 之间的男性进行索引扫描时进行重新筛查。
