Siika Antti, Axelsson Anton, Fattahi Nina, Roy Joy, Öhman Daniel, Linné Anneli, Hultgren Rebecka
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Vascular Surgery, Karolinska Institutet and University Hospital, Stockholm, Sweden.
Br J Surg. 2025 Aug 1;112(8). doi: 10.1093/bjs/znaf156.
Temporal trends of infrarenal aortic diameters and their association with long-term mortality were explored in a population-based abdominal aortic aneurysm (AAA) screening programme. Additionally, changes in risk factor distribution and outcomes among the individuals with an AAA were analysed over the 14-year study period.
In this population-based cohort study between 2010 and 2023, all 65-year-old men who had been invited to screening for AAA were studied (152 000). Aortic diameter and date of death were extracted from the regional screening database.
Some 117 120 men were examined, with reductions in mean(s.d.) aortic diameter (18.6(3.3) mm to 18.1(2.8) mm) and AAA prevalence (1.32% to 0.69%). The prevalence of small aortas (<17 mm) was 18.5% and that of subaneurysmal aortas (25-29 mm) was 1.1%. Initial aortic diameter showed a non-linear association with mortality (P < 0.001). The 5-year mortality was 3.8% for men with a normal aorta, 5.5% for men with a small aorta, 8.1% for men with a subaneurysmal aorta, and 9.5% for men with an AAA. The incidence of non-smoking men with an AAA remained constant, while a decline in the number of men with a smoking history was observed. Smoking cessation influenced timing of surgery and survival, with a 5-year mortality of 11.1% in current smokers versus 5.6% in non-smokers.
There has been a decline in the prevalence of AAA and subaneurysmal aortas, and a slight rise in men with small aortas. Men with small or aneurysmatic aortas are at 1.5-2.5 times higher risk of mortality at 5 years compared with men with normal diameters. Smoking cessation halts the progression to AAA surgery and is associated with reduced mortality.
在一项基于人群的腹主动脉瘤（AAA）筛查项目中，探讨了肾下腹主动脉直径的时间趋势及其与长期死亡率的关联。此外，还分析了在14年研究期间AAA患者的危险因素分布和结局变化。
在这项2010年至2023年的基于人群的队列研究中，对所有受邀参加AAA筛查的65岁男性（152000人）进行了研究。从区域筛查数据库中提取主动脉直径和死亡日期。
约117120名男性接受了检查，平均（标准差）主动脉直径减小（从18.6（3.3）mm降至18.1（2.8）mm），AAA患病率降低（从1.32%降至0.69%）。小主动脉（<17mm）的患病率为18.5%，亚动脉瘤性主动脉（25 - 29mm）的患病率为1.1%。初始主动脉直径与死亡率呈非线性关联（P < 0.001）。主动脉正常的男性5年死亡率为3.8%，小主动脉男性为5.5%，亚动脉瘤性主动脉男性为8.1%，AAA男性为9.5%。AAA非吸烟男性的发病率保持不变，而有吸烟史的男性数量有所下降。戒烟影响手术时机和生存率，当前吸烟者的5年死亡率为11.1%，非吸烟者为�.6%。
AAA和亚动脉瘤性主动脉的患病率有所下降，小主动脉男性略有增加。与主动脉直径正常的男性相比，小主动脉或动脉瘤性主动脉男性在5年时的死亡风险高1.5 - 2.5倍。戒烟可阻止疾病进展至AAA手术，并与死亡率降低相关。
