Study highlights risk factors and need to screen women for AAAs.
A new study in the October 2007 issue of the Journal of Vascular Surgery presents the largest screening study ever done on women with abdominal aortic aneurysms (AAAs). A total of 10,012 women and 7,528 men were screened for AAA in the study. The overall prevalence of AAA was only 0.7% in women (74 patients) compared to 3.9% (291 patients) in men, although females with multiple risk factors were more likely to have an aneurysm. “We found AAAs were more likely to be found in women 65 years and older, with a history of heart disease or tobacco use, a prevalence rate as high as 6.4%,” said senior author Dr K Craig Kent, Chief of Vascular Surgery at New York Presbyterian Hospital in New York City. “Our results showed that females who are current or former smokers are four times more likely than non-smokers to have aneurysmal disease; also, women with a prior heart attack, heart bypass surgery or coronary angioplasty are 3.6 times more likely to have an aneurysm.” He noted that in the past, most data has been accumulated to support the screening of all men between the ages of 65 to 75 years who have ever smoked. He added that it has not been well established whether the same factors that increase the likelihood of AAA in men have the same effect in women, and whether there are subgroups of women at sufficiently high risk of AAA to undergo screening. “Although women are generally believed to have a lower prevalence rate of AAA than men, prior studies have demonstrated that women are at increased risk of death following rupture and are at increased risk of rupturing aneurysms of smaller sizes,” added Kent. “Identifying subgroups of women who have a heightened risk of AAA is extremely important, as they may be as likely to benefit from screening programs as men with similar risk factors. “The greatest potential for improving the mortality rate associated with AAA depends on early detection and elective repair of AAA before rupture,” concluded Kent. “Recently, reductions in the death rate from AAA have been demonstrated following the screening of specific patient groups with a brief non-invasive ultrasound examination. For screening to be clinically feasible or cost effective, it should be directed at both male and female patients who have an increased likelihood of harboring the disease being sought.” From January 1, 2007, new Medicare beneficiaries at risk from AAAs were given the opportunity to be screened using ultrasound technology. This screening is part of the Welcome to Medicare physical for many seniors who have certain risk factors. The screening program is a result of the Screen Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act, passed by the US Congress in November 2005. The Act was conceived by the Society for Vascular Surgery (SVS) in early 2004 and was aided by the US Preventative Services Task Force. At risk are men who have smoked sometime during their lives, and men and women with a family history of AAA. However, due to budget constraints, only new entrants to Medicare part B will be screened, therefore seniors who have already had their ‘Welcome to Medicare’ physical exam will not be retrospectively screened. By restricting the screening to only new Medicare entrants, the congressional budget estimate is only US$200 million over five years. The SVS wants to increase the uptake of screening benefits such as this, which is currently only at around 10–15% of those eligible.