腹主动脉瘤的生存、患病率、进展及修复：三项三十年随机对照筛查试验的结果
Survival, Prevalence, Progression and Repair of Abdominal Aortic Aneurysms: Results from Three Randomised Controlled Screening Trials Over Three Decades.
作者信息
Lindholt Jes S, Diederichsen Axel C, Rasmussen Lars M, Frost Lars, Steffensen Flemming H, Lambrechtsen Jess, Urbonaviciene Grazina, Busk Martin, Egstrup Kenneth, Kristensen Katrine L, Behr Andersen Carsten, Søgaard Rikke
机构信息
Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.
Elitary Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense, Denmark.
出版信息
Clin Epidemiol. 2020 Jan 23;12:95-103. doi: 10.2147/CLEP.S238502. eCollection 2020.
AIM
The prevalence and mortality of abdominal aortic aneurysms (AAA) has been reported to decline. The aim of this study is to compare survival, prevalence, and repair rate of AAA in Denmark in the 1990s, the 2000s and the 2010s - and to examine any change in factors known to influence the prevalence.
METHODS
Baseline status and up to 5-year outcomes of 34,079 general population men aged 65-74 were obtained from three RCTs; the Viborg study (1994-1998, n=4,860), the Viborg Vascular (VIVA) trial (2008-2011, n=18,748), and the Danish Cardiovascular (DANCAVAS) trial (2015-2018, n=10,471). After the millennium (VIVA and DANCAVAS) men with AAA were further offered low dose aspirin and statins. Follow-up data were not available for the DANCAVAS trial yet.
RESULTS
Across the three decades, the AAA prevalence was 3.8% (Reference), 3.3% (p<0.001) and 4.2% (p=0.882), the proportion of smokers were 62%, 42% and 34% (p<0.001) amongst men with AAA, but AAA risk associations with smoking increased during the decades suggesting increased tobacco consumption of smokers. In addition, the proportions of attenders with ischemic heart disease or stroke increased significantly. The aneurysmal progression rate in the 1990s was 2.90 vs 2.98 mm/year in the 2000s (p=0.91). The need for preventive AAA repair increased insignificantly in the 2000s (Age adj. HR= 1.29, 95% C.I.: 0.95; 1.71, p=0.10), and mortality of men with screen-detected AAA was lower in the 2000s compared to the 1990s (Age-adj. HR= 0.28, 95% C.I.: 0.22; 0.36, p<0.001).
CONCLUSION
The Danish prevalence of AAA today compares to the nineties. Unchanged aneurysmal progression rates combined with improved survival of men at risk of AAA leave them in longer time to develop an AAA, be diagnosed and to need later aneurysmal repair or experience rupture.
CLINICAL TRIAL REGISTRATIONS
Viborg study: No possibility of registration in the nineties. VIVA: NCT00662480, URL: https://clinicaltrials.gov/show/NCT00662480, DANCAVAS: ISRCTN12157806, URL: http://www.isrctn.com/ISRCTN12157806.
目的
据报道，腹主动脉瘤（AAA）的患病率和死亡率有所下降。本研究的目的是比较丹麦20世纪90年代、21世纪00年代和21世纪10年代AAA的生存率、患病率和修复率，并研究已知影响患病率的因素的任何变化。
方法
从三项随机对照试验中获取了34079名65 - 74岁普通男性的基线状况和长达5年的随访结果；维堡研究（1994 - 1998年，n = 4860）、维堡血管（VIVA）试验（2008 - 2011年，n = 18748）和丹麦心血管（DANCAVAS）试验（2015 - 2018年，n = 10471）。在千年之后（VIVA和DANCAVAS），患有AAA的男性还被提供了低剂量阿司匹林和他汀类药物。DANCAVAS试验的随访数据尚未可得。
结果
在这三个十年中，AAA患病率分别为3.8%（参照）、3.3%（p < 0.001）和4.2%（p = 0.882），AAA男性患者中吸烟者的比例分别为62%、42%和34%（p < 0.001），但在这几十年中AAA与吸烟的风险关联增加，表明吸烟者的烟草消费量增加。此外，患有缺血性心脏病或中风的参与者比例显著增加。20世纪90年代的动脉瘤进展率为2.90，21世纪00年代为2.98毫米/年（p = 0.91）。2000年代预防性AAA修复的需求增加不显著（年龄校正风险比 = 1.29，95%置信区间：0.95；1.71，p = 0.10），与20世纪90年代相比，2000年代经筛查发现AAA的男性死亡率更低（年龄校正风险比 = 0.28，95%置信区间：0.22；0.36，p < 0.001）。
结论
丹麦如今的AAA患病率与九十年代相当。动脉瘤进展率不变，同时有AAA风险的男性生存率提高，使他们有更长时间发展为AAA、被诊断以及需要后期进行动脉瘤修复或发生破裂。
临床试验注册
维堡研究：九十年代无法注册。VIVA：NCT00662480，网址：https://clinicaltrials.gov/show/NCT00662480，DANCAVAS：ISRCTN12157806，网址：http://www.isrctn.com/ISRCTN12157806 。
Zotero 插件