Persson Sven-Erik, Holsti Mari, Mani Kevin, Wanhainen Anders
Department of Diagnostics and Intervention, Surgery, Umeå University, Umeå, Sweden.
Department of Diagnostics and Intervention, Surgery, Umeå University, Umeå, Sweden.
J Vasc Surg. 2025 Feb;81(2):335-341.e6. doi: 10.1016/j.jvs.2024.10.012. Epub 2024 Oct 17.
Previous studies suggest partly different risk factor profiles of thoracic aortic aneurysms (TAAs) and abdominal aortic aneurysms (AAAs), but prospective data are scarce. The purpose of this prospective population-based case-control study was to investigate differences in risk factor profile between TAAs and AAAs.
Participants in two prospective population-based studies, the Västerbotten Intervention Project (VIP) and the Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study, between 1986 and 2010, underwent cardiovascular risk assessments, including blood samples, oral glucose tolerance test, blood pressure readings, and a self-reported health questionnaire. All individuals who were later diagnosed with TAAs or AAAs were identified. Age, sex, and time-matched controls were selected from the same cohorts, aiming at four controls/case. Adjusted odds ratios (aORs) for potential risk factors for later diagnosis of TAAs and AAAs, respectively, were estimated by multivariate conditional logistic regression analyses.
From a total of 96,196 individuals with prospectively collected data in the VIP/MONICA cohort, a total of 236 individuals with AAAs (181 men and 55 women) and 935 matched controls, and 168 individuals with TAAs (115 men and 53 women) and 662 controls were included. The average age at baseline examination was 57.0 ± 5.7 years for AAA cases and controls, and 52.1 ± 8.8 years for TAA cases and controls. Mean time between baseline examination and diagnosis of AAAs/TAAs was 12.1 and 11.7 years, respectively. There was a clear difference in risk factor profile between AAAs and TAAs. Smoking, hypertension, and coronary artery disease were significantly associated with later diagnosis of AAAs, with highest aORs for a history of smoking (aOR, 10.3; 95% confidence interval [CI], 6.3-16.8). For TAAs, hypertension was the only positive risk factor (aOR, 1.7; 95% CI, 1.1-2.7), whereas smoking was not associated. Diabetes was not associated with either AAAs or TAAs; neither was self-reported physical activity.
In this prospective, population-based, case-control study, risk factor profile differed between AAAs and TAAs. This suggests a partially different etiology for TAAs and AAAs.
既往研究提示胸主动脉瘤（TAA）和腹主动脉瘤（AAA）的危险因素谱存在部分差异，但前瞻性数据较少。这项基于人群的前瞻性病例对照研究旨在调查TAA和AAA危险因素谱的差异。
在1986年至2010年期间，两项基于人群的前瞻性研究，即韦斯特博滕干预项目（VIP）和心血管疾病趋势和决定因素监测（MONICA）研究的参与者接受了心血管风险评估，包括血液样本采集、口服葡萄糖耐量试验、血压测量以及一份自我报告的健康问卷。确定了所有后来被诊断为TAA或AAA的个体。从同一队列中选择年龄、性别和时间匹配的对照，目标是4名对照/病例。通过多变量条件逻辑回归分析分别估计TAA和AAA后期诊断潜在危险因素的调整比值比（aOR）。
在VIP/MONICA队列中，共有96,196名个体有前瞻性收集的数据，其中包括236例AAA患者（181名男性和55名女性）及935名匹配对照，168例TAA患者（115名男性和53名女性）及662名对照。AAA病例和对照在基线检查时的平均年龄为57.0±5.7岁，TAA病例和对照为52.1±8.8岁。从基线检查到AAA/TAA诊断的平均时间分别为12.1年和11.7年。AAA和TAA的危险因素谱存在明显差异。吸烟、高血压和冠状动脉疾病与AAA的后期诊断显著相关，吸烟史的aOR最高（aOR，10.3；95%置信区间[CI]，6.3 - 16.8）。对于TAA，高血压是唯一的阳性危险因素（aOR，1.7；95%CI，1.1 - 2.7），而吸烟与之无关。糖尿病与AAA或TAA均无关；自我报告的身体活动也无关。
在这项基于人群的前瞻性病例对照研究中，AAA和TAA的危险因素谱不同。这提示TAA和AAA的病因存在部分差异。
