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Schattner A. Comprehensive Evidence-Based Health Maintenance. Am J Med 2024:S0002-9343(24)00202-X. [PMID: 38582322 DOI: 10.1016/j.amjmed.2024.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/08/2024]
Abstract
The potential of primary prevention to prevent, delay, or ameliorate disease is immense. However, the total spending on preventive services in the United States remains astoundingly small and represents a meager 3.5% of total health care spending. Moreover, training focused on prevention in medical schools is often neglected, and time-constrained primary providers frequently omit effective preventive and early detection measures, or perform them perfunctorily. Indeed, preventable conditions of serious consequences including "premature" mortality, cardiovascular events, and major organ failure are ubiquitous with the global obesity and diabetes epidemics, and the ongoing high prevalence of noxious habits and drug abuse. Although each aspect has been the subject of extensive research, a succinct evidence-based summary is scarce. We have conducted a review of high-quality evidence (systematic reviews, meta-analyses, and practice guidelines) over the last 20 years to extract the best updated recommendations on comprehensive disease prevention and approved screening, briefly citing significant risk reductions by lifestyle interventions, pharmacological prevention, cancer screening, other endorsed screening, immunizations, and issues in the patient-provider interface.
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Affiliation(s)
- Ami Schattner
- The Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel.
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Cote CL, Jessula S, Kim Y, Cooper M, McDougall G, Casey P, Dua A, Lee MS, Smith M, Herman C. Trends in Incidence of Abdominal Aortic Aneurysm Rupture, Repair, and Mortality in Nova Scotia. Ann Vasc Surg 2023; 95:62-73. [PMID: 36509371 DOI: 10.1016/j.avsg.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The purpose of this study was to examine sex-based trends in incidence of elective abdominal aortic aneurysm (AAA), ruptured AAA, ruptured AAA repair, and AAA-related mortality. METHODS A retrospective analysis of patients presenting with AAA from 2005 to 2015 was conducted. Rates of elective AAA repair, ruptured AAA, ruptured AAA repair, and mortality were obtained from linking provincial administrative data using medical services insurance billing number. The age-adjusted incidence of elective AAA repair, overall rate of ruptured AAA, ruptured AAA repair, and AAA-related mortality was calculated for each sex based on Canadian census estimates, adjusted to the Canadian standard population. Weighted linear regression was performed to analyze trends in incidence over time. RESULTS One thousand nine hundred eighty-six elective AAA repairs were identified, of which 1,098 were repaired open and 898 underwent endovascular abdominal aneurysm repair (EVAR). Five hundred and seventy ruptured AAAs were identified, of which 295 (52%) were repaired: 259 open and 36 EVAR. The proportion of ruptured AAA that was repaired did not change over time (P = 0.54). The proportion repairs performed using EVAR increased significantly in both elective (P < 0.001) and rupture repairs (P < 0.001). During the study period, 662 patients died of AAA-associated mortality. The average incidence of elective AAA repair in men was 29.3 (95% confidence interval (CI): 27.8 to 30.8) per 100,000 and decreased over time (P = 0.04), whereas the average incidence in women was 9.2 [8.3 to 10.0] and stable (P = 0.07). The incidence of open elective AAA repair was 10.5 [9.9-11.1] with a decreasing trend over time (P < 0.001) and EVAR was 9.0 (8.5-9.6) with an increasing trend over time (P < 0.001). A decreasing trend of overall ruptured AAA (5.4 [5.0-5.9], P < 0.001), ruptured AAA repair (2.9 [2.5-3.2], P = 0.02), and of AAA-related mortality (6.2 [5.8-6.8], P < 0.001) was found, with consistent trends in both sexes. The incidence of open ruptured AAA repair decreased over time (P = 0.001) whereas the incidence of ruptured EVAR remained stable (P = 0.23). CONCLUSIONS The incidence of elective AAA repair is decreasing in males but not females, whereas the incidence of rupture has decreased in both sexes. This has translated into reduced incidence of AAA-related mortality. Increased adoption of EVAR for ruptured AAA should continue these trends.
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Affiliation(s)
- Claudia L Cote
- Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Canada.
| | - Samuel Jessula
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Young Kim
- Division of Vascular and Endovascular Surgery, Duke University, Durham, NC
| | - Matthew Cooper
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Garrett McDougall
- Department of Emergency Medicine, McMaster University, Hamilton, Canada
| | - Patrick Casey
- Division of Vascular Surgery, Department of Surgery, Dalhousie University, Halifax, Canada
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Min S Lee
- Division of Vascular Surgery, Department of Surgery, Dalhousie University, Halifax, Canada
| | - Matthew Smith
- Division of Vascular Surgery, Department of Surgery, Dalhousie University, Halifax, Canada
| | - Christine Herman
- Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Canada; Division of Vascular Surgery, Department of Surgery, Dalhousie University, Halifax, Canada
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Spanos K, Nana P, Roussas N, Batzalexis K, Karathanos C, Baros C, Giannoukas AD. Outcomes of a pilot abdominal aortic aneurysm screening program in a population of Central Greece. INT ANGIOL 2023; 42:59-64. [PMID: 36507795 DOI: 10.23736/s0392-9590.22.04962-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) screening has contributed in the decrease of aneurysm related and all-cause mortality. The objective of our study is to present our experience from the only existing pilot AAA screening program in Greece. METHODS Men from both urban and rural areas in Central Greece, aged >60 years old without a previously known diagnosis of AAA were invited through the public primary health care units to participate to a screening program. Demographics, comorbidities, family history and anthropometric data were recorded. Aortic diameter values of >30 mm and common iliac artery (CIA) diameter values of >18 mm, were defined as aneurysmatic by ultrasound. RESULTS The screening program included 1256 individuals (1256/1814; response rate 69%). The incidence of AAA and CIA aneurysm was 2% (25/1256) and 2.3% (29/1256), respectively. Increased age (P<0.042), tobacco use (P<0.006) and its duration (P<0.008) were related to higher incidence of AAA, while diabetes mellitus to lower one (P<0.048). Multivariate analysis showed that AAA was associated to longer duration of smoking (1.05, CI: 0.02-6.6; P=0.01). Statin and antiplatelet therapy were administrated in 40% (10/25) and 44% (11/25), respectively of individuals with AAA. An additional analysis was provided between subjects with AD of 25-30 mm and AD <25 mm. In multivariate analysis, no factor was associated to AD of 25-30 mm. CONCLUSIONS The incidence of AAA and CIA aneurysm in Central Greece is 2% and 2.3%, respectively. Smoking duration was the strongest associated factor with AAA incidence. This provides to healthcare policy makers a strong valid point for the prevention strategies.
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Affiliation(s)
- Konstantinos Spanos
- Department of Vascular Surgery, School of Health Sciences, Faculty of Medicine, University Hospital of Larissa, University of Thessaly, Larissa, Greece -
| | - Petroula Nana
- Department of Vascular Surgery, School of Health Sciences, Faculty of Medicine, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Nikolaos Roussas
- Department of Vascular Surgery, School of Health Sciences, Faculty of Medicine, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Konstantinos Batzalexis
- Department of Vascular Surgery, School of Health Sciences, Faculty of Medicine, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Christos Karathanos
- Department of Vascular Surgery, School of Health Sciences, Faculty of Medicine, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Christos Baros
- Department of Vascular Surgery, School of Health Sciences, Faculty of Medicine, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Athanasios D Giannoukas
- Department of Vascular Surgery, School of Health Sciences, Faculty of Medicine, University Hospital of Larissa, University of Thessaly, Larissa, Greece
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Harnessing the Electronic Medical Record to Improve the Utilization of Ultrasound Screening for Abdominal Aortic Aneurysms. J Am Coll Radiol 2022; 19:1338-1342. [PMID: 36273502 DOI: 10.1016/j.jacr.2022.09.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/08/2022] [Accepted: 09/15/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE The US Preventive Services Task Force recommends one-time ultrasound screening to detect abdominal aortic aneurysms (AAAs) in male smokers. Despite this recommendation, AAA screening is still underutilized. The aim of this study was to determine the effectiveness of an electronic medical record (EMR) automated ordering program in increasing AAA screening at an integrated health care system. METHODS This study was a retrospective chart review of patients who underwent ultrasound screening for AAA from January 1, 2016, to December 31, 2021, at a geographically isolated integrated health care system. An automated ordering system was implemented in a stepwise fashion within our EMR beginning in March 2019. The number of ultrasound studies and the incidence of AAA were compared between manual referral and EMR automated ordering periods. RESULTS A total of 4,176 patients met the inclusion criteria for this study, among whom 148 aneurysms were identified. There was an increase in the average number of monthly screening ultrasound studies performed during the automated ordering period compared with the manual referral period (105 vs 16.3 studies, P < .001). The incidence of AAA was lower in the automated ordering period compared with the manual referral period (3.2% vs 5.3%, P = .013). CONCLUSIONS An EMR automated ordering program can increase the number of screening ultrasound studies performed for AAA, which may help clinicians identify more high-risk aneurysms requiring urgent repair.
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Balakhonova TV, Ershova AI, Ezhov MV, Barbarash OL, Bershtein LL, Bogachev VY, Voevoda MI, Genkel VV, Gurevich VS, Duplyakov DV, Imaev TE, Konovalov GA, Kosmacheva ED, Lobastov KV, Mitkova MD, Nikiforov VS, Rotar OP, Suchkov IA, Yavelov IS, Mitkov VV, Akchurin RS, Drapkina OM, Boytsov SA. Focused vascular ultrasound. Consensus of Russian experts. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
| | - A. I. Ershova
- National Medical Research Center for Therapy and Preventive Medicine
| | - M. V. Ezhov
- E.I. Chazov National Medical Research Center of Cardiology
| | - O. L. Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases
| | | | | | - M. I. Voevoda
- Federal Research Center of Fundamental and Translational Medicine
| | | | - V. S. Gurevich
- I.I. Mechnikov North-Western State Medical University; Saint Petersburg State University; L.G. Sokolov NorthWestern District Research and Clinical Center
| | - D. V. Duplyakov
- Samara State Medical University; V.P. Polyakov Samara Regional Clinical Cardiology Dispensary
| | - T. E. Imaev
- E.I. Chazov National Medical Research Center of Cardiology
| | | | | | | | - M. D. Mitkova
- Russian Medical Academy of Continuous Professional Education
| | | | | | | | - I. S. Yavelov
- National Medical Research Center for Therapy and Preventive Medicine
| | - V. V. Mitkov
- Russian Medical Academy of Continuous Professional Education
| | - R. S. Akchurin
- E.I. Chazov National Medical Research Center of Cardiology
| | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
| | - S. A. Boytsov
- E.I. Chazov National Medical Research Center of Cardiology
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Pratesi C, Esposito D, Apostolou D, Attisani L, Bellosta R, Benedetto F, Blangetti I, Bonardelli S, Casini A, Fargion AT, Favaretto E, Freyrie A, Frola E, Miele V, Niola R, Novali C, Panzera C, Pegorer M, Perini P, Piffaretti G, Pini R, Robaldo A, Sartori M, Stigliano A, Taurino M, Veroux P, Verzini F, Zaninelli E, Orso M. Guidelines on the management of abdominal aortic aneurysms: updates from the Italian Society of Vascular and Endovascular Surgery (SICVE). THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:328-352. [PMID: 35658387 DOI: 10.23736/s0021-9509.22.12330-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The objective of these Guidelines was to revise and update the previous 2016 Italian Guidelines on Abdominal Aortic Aneurysm Disease, in accordance with the National Guidelines System (SNLG), to guide every practitioner toward the most correct management pathway for this pathology. The methodology applied in this update was the GRADE-SIGN version methodology, following the instructions of the AGREE quality of reporting checklist as well. The first methodological step was the formulation of clinical questions structured according to the PICO (Population, Intervention, Comparison, Outcome) model according to which the Recommendations were issued. Then, systematic reviews of the Literature were carried out for each PICO question or for homogeneous groups of questions, followed by the selection of the articles and the assessment of the methodological quality for each of them using qualitative checklists. Finally, a Considered Judgment form was filled in for each clinical question, in which the features of the evidence as a whole are assessed to establish the transition from the level of evidence to the direction and strength of the recommendations. These guidelines outline the correct management of patients with abdominal aortic aneurysm in terms of screening and surveillance. Medical management and indication for surgery are discussed, as well as preoperative assessment regarding patients' background and surgical risk evaluation. Once the indication for surgery has been established, the options for traditional open and endovascular surgery are described and compared, focusing specifically on patients with ruptured abdominal aortic aneurysms as well. Finally, indications for early and late postoperative follow-up are explained. The most recent evidence in the Literature has been able to confirm and possibly modify the previous recommendations updating them, likewise to propose new recommendations on prospectively relevant topics.
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Affiliation(s)
- Carlo Pratesi
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy
| | - Davide Esposito
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy -
| | | | - Luca Attisani
- Department of Vascular Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Raffaello Bellosta
- Department of Vascular Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Filippo Benedetto
- Department of Vascular Surgery, AOU Policlinico Martino, Messina, Italy
| | | | | | - Andrea Casini
- Department of Intensive Care, Careggi University Hospital, Florence, Italy
| | - Aaron T Fargion
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy
| | - Elisabetta Favaretto
- Department of Angiology and Blood Coagulation, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Antonio Freyrie
- Department of Vascular Surgery, Parma University Hospital, Parma, Italy
| | - Edoardo Frola
- Department of Vascular Surgery, AO S. Croce e Carle, Cuneo, Italy
| | - Vittorio Miele
- Department of Diagnostic Imaging, Careggi University Hospital, Florence, Italy
| | - Raffaella Niola
- Department of Vascular and Interventional Radiology, AORN Cardarelli, Naples, Italy
| | - Claudio Novali
- Department of Vascular Surgery, GVM Maria Pia Hospital, Turin, Italy
| | - Chiara Panzera
- Department of Vascular Surgery, AOU Sant'Andrea, Rome, Italy
| | - Matteo Pegorer
- Department of Vascular Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Paolo Perini
- Department of Vascular Surgery, Parma University Hospital, Parma, Italy
| | | | - Rodolfo Pini
- Department of Vascular Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Alessandro Robaldo
- Department of Vascular Surgery, Ticino Vascular Center - Lugano Regional Hospital, Lugano, Switzerland
| | - Michelangelo Sartori
- Department of Angiology and Blood Coagulation, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | | | | | | | - Fabio Verzini
- Department of Vascular Surgery, AOU Città della Salute e della Scienza, Turin, Italy
| | - Erica Zaninelli
- Department of General Medical Practice, ATS Bergamo - ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Massimiliano Orso
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, Perugia, Italy
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Goodwin GR, Bestwick JP, Noyce AJ. The potential utility of smell testing to screen for neurodegenerative disorders. Expert Rev Mol Diagn 2022; 22:139-148. [PMID: 35129037 DOI: 10.1080/14737159.2022.2037424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Loss of smell is a common early feature of neurodegenerative diseases including Alzheimer's and Parkinson's disease. Identifying these conditions in their early stages is important to understand more about early pathophysiological events and the development of disease modifying therapies. Smell testing may be an effective future tool for screening large populations for early neurodegeneration. AREAS COVERED : In this review, we appraise the evidence for, and discuss the likelihood of, the use of smell testing in large screening programs to detect early neurodegeneration. We evaluate the predictive power of smell tests for neurodegenerative disease, compare performance to other established screening programs, and discuss ethical and practical considerations and limitations. EXPERT OPINION : Even if disease modifying therapies were available for neurodegenerative disease, smell tests alone are unlikely to have high enough predictive power to be used in a future screening program. However, we believe they could be a valuable component of a short battery of tests or part of a stepwise process that together could more accurately identify early neurodegeneration in large populations.
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Affiliation(s)
- Gregory R Goodwin
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, E1 4NS, UK
| | - Jonathan P Bestwick
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, E1 4NS, UK
| | - Alastair J Noyce
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, E1 4NS, UK
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Novak R, Hrkac S, Salai G, Bilandzic J, Mitar L, Grgurevic L. The Role of ADAMTS-4 in Atherosclerosis and Vessel Wall Abnormalities. J Vasc Res 2022; 59:69-77. [PMID: 35051931 DOI: 10.1159/000521498] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/13/2021] [Indexed: 11/19/2022] Open
Abstract
Extracellular matrix proteins are regulated by metzincin proteases, like the disintegrin metalloproteinases with thrombospondin motifs (ADAMTS) family members. This review focuses on the emerging role which ADAMTS-4 might play in vascular pathology, which has implications for atherosclerosis and vessel wall abnormalities, as well as for the resulting diseases, such as cardiovascular and cerebrovascular disease, aortic aneurysms, and dissections. Major substrates of ADAMTS-4 are proteoglycans expressed physiologically in smooth muscle cells of blood vessels. Good examples are versican and aggrecan, principal vessel wall proteoglycans that are targeted by ADAMTS-4, driving blood vessel atrophy, which is why this metzincin protease was implicated in the pathophysiology of vascular diseases with an atherosclerotic background. Despite emerging evidence, it is important not to exaggerate the role of ADAMTS-4 as it is likely only a small piece of the complex atherosclerosis puzzle and one that could be functionally redundant due to its high structural similarity to other ADAMTS family members. The therapeutic potential of inhibiting ADAMTS-4 to halt the progression of vascular disease after initialization of treatment is unlikely. However, it is not excluded that it might find a purpose as a biomarker of vascular disease, possibly as an indicator in a larger cytokine panel.
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Affiliation(s)
- Rudjer Novak
- Department of Proteomics, Center for Translational and Clinical Research, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Stela Hrkac
- Department of Proteomics, Center for Translational and Clinical Research, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Grgur Salai
- Department of Proteomics, Center for Translational and Clinical Research, School of Medicine, University of Zagreb, Zagreb, Croatia.,Teaching Institute of Emergency Medicine of the City of Zagreb, Zagreb, Croatia
| | - Josko Bilandzic
- Department of Proteomics, Center for Translational and Clinical Research, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Luka Mitar
- Department of Proteomics, Center for Translational and Clinical Research, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Lovorka Grgurevic
- Department of Proteomics, Center for Translational and Clinical Research, School of Medicine, University of Zagreb, Zagreb, Croatia.,Department of Anatomy, "Drago Perovic," School of Medicine, University of Zagreb, Zagreb, Croatia
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Abdominal Aortic Screening Is a Priority for Health in Smoker Males: A Study on Central Italian Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010591. [PMID: 35010845 PMCID: PMC8744758 DOI: 10.3390/ijerph19010591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/02/2022] [Indexed: 11/16/2022]
Abstract
Abdominal aortic aneurysm (AAA) is a major public health problem. In the last decade, in some European countries, abdominal aortic screening (AAS) is emerging as a potential prevention for the rupture of AAA. The goals of our study were to estimate AAA prevalence and risk factors in males and females in a central Italian population, also defining the cost-effectiveness of AAS programs. A pilot study screening was conducted between 1 January 2015 and 31 December 2019 in the municipality of Teramo (Abruzzo Region, Italy) in a group of men and women, ranging from the age of 65 to 79, who were not previously operated on for AAA. The ultrasound was performed by means of Acuson sequoia 512 Simens with a Convex probe. The anterior posterior of the infra-renal aorta was evaluated. The odds ratio values (ORs) were used to evaluate the risk of AAA, and the following determinants were taken into consideration: gender, smoke use, hypertension, and ischemic heart disease. We also estimated the direct costs coming from aneurysmectomy (surgical repair or endovascular aneurysms repair—EVAR). A total of 62 AAA (2.7%, mean age 73.8 ± 4.0) were diagnosed, of which 57 were in men (3.7%, mean age 73.6 ± 4.0) and 5 were in women (0.7%, mean age 74.3 ± 4.1). Male gender and smoke use are more important risk factors for AAA ≥ 3 cm, respectively: OR = 5.94 (2.37–14.99, p < 0.001) and OR = 5.21 (2.63–10.30, p < 0.000). A significant increase in OR was noted for AAA ≥ 3 cm and cardiac arrhythmia and ischemic heart disease, respectively: OR = 2.81 (1.53–5.15, p < 0.000) and OR = 2.76 (1.40–5.43, p = 0.006). Regarding the cost analysis, it appears that screening has contributed to the reduction in costs related to urgency. In fact, the synthetic indicator given by the ratio between the DRGs (disease related group) relating to the emergency and those of the elective activity went from 1.69 in the year prior to the activation of the screening to a median of 0.39 for the five-year period of activation of the screening. It is important to underline that the results of our work confirm that the screening activated in our territory has led to a reduction in the expenditure for AAA emergency interventions, having increased the planned interventions. This must be a warning for local stakeholders, especially in the post-pandemic period, in order to strengthen prevention.
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Underutilization of Guideline-based Abdominal Aortic Aneurysm Screening in an Academic Health System. Ann Vasc Surg 2021; 83:184-194. [PMID: 34942338 DOI: 10.1016/j.avsg.2021.11.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/18/2021] [Accepted: 11/29/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The US Preventive Services Task Force (USPSTF) recommends a 1-time screening for AAA with ultrasonography in men aged 65-75 who have ever smoked. Our objectives were to identify the AAA screening rates in a large academic health system and assess factors associated with receipt of screening. METHODS Data were extracted from electronic health record data from the Duke University Health System and the US Census Bureau. Index screening eligibility date was defined as the 65th birthdate for male patients with a history of smoking. Patients with an index screening eligibility date between 1/1/2016 and 12/31/2018 were included in the study population and followed through 12/31/2019. Screened patients were identified by procedure codes for ultrasonography, CT or MRI. RESULTS Among 6,682 eligible patients who turned 65 years old between 1/1/2016 and 12/31/2018 with at least 1 year of follow-up, only 463 (6.9%) received AAA screening during the study period. The odds of receiving AAA screening within 1 year of index eligibility were 27% lower for Black patients compared to whites [OR=0.73, 95% CI (0.58,0.93)]. Patients who visited a PCP or had hypertension had 75% and 41% greater odds of receiving screening, respectively [OR 1.75, 95% CI (1.36,2.25)] and [OR 1.41 95% CI (1.11,1.80)] compared with patients who did not. Among 4,580 men with 2 years of follow-up, AAA screening rate increased to 13.0%. Patients who visited a PCP had 64% greater odds of receiving screening within 2 years of index eligibility compared to those who did not [OR=1.64, 95% CI (1.30,2.06)]. CONCLUSION Screening for AAA per USPSTF guidelines is underutilized with evidence of a racial disparity. Although PCP visit is the most consistent predictor of screening, provider screening rates are low.
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Lee ES, Chun KC, Gupta A, Anderson RC, Irwin ZT, Newton EA, Jaime-Hughes N, Datta S. Costs of abdominal aortic aneurysm care at a regional Veterans Affairs medical center with the implementation of an abdominal aortic aneurysm screening program. J Vasc Surg 2021; 75:1253-1259. [PMID: 34655684 DOI: 10.1016/j.jvs.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) screening has demonstrated to be cost-effective in reducing AAA-related morbidity and all-cause mortality. However, the downstream care costs of an implemented AAA screening in clinical practice have not been reported. The purpose of this study is to determine direct regional Department of Veterans Affairs (VA) costs in implementing and sustaining an AAA screening program over a 10-year period. METHODS A cost data analysis (adjusted to 2021 U.S. dollars) of an AAA screening program was conducted from 2007 to 2016, where 19,649 veteran patients aged 65-75 with a smoking history were screened at a regional VA medical center. A decision support system tracked direct and indirect encounter costs from Medicare billing codes associated with AAA care. Costs from a patient's initial screening, follow-up imaging, to AAA repair or at the end of the analysis period, March 31, 2021, were recorded. Costs for AAA repairs outside the VA system were also tracked. RESULTS A total of 1,183 patients screened were identified with an AAA ≥3.0 cm without history of repair. Estimated screening costs were $2.8 million or $280,000 annually ($143/screening) in the care of 19,649 screened patients. There were 221 patients who required repair (143 repairs in VA, 78 repairs outside VA). The average cost of elective endovascular repair was $43,021 and that of open repair was $49,871. The total costs for all elective repairs were $9,692,591. Screening, implementation, maintenance, and surgical repair cost involved in the management of patients with AAA disease was $13.7 million, with $10,686 per life-year lived after repair (5.8 ± 3.5 mean life-years) and $490 per life-year lived after screening (6.9 ± 3.5 mean life-years) for all patients screened. There were 13 deaths of unknown causes and one patient with a ruptured AAA that required emergency repair at a cost of $124,392. CONCLUSIONS Despite known limitations, the implementation of an AAA ultrasound screening program is feasible, cost-effective, and a worthwhile endeavor.
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Affiliation(s)
- Eugene S Lee
- Department of Surgery, Sacramento Veterans Affairs Medical Center, Mather, Calif.
| | - Kevin C Chun
- Department of Research, Sacramento Veterans Affairs Medical Center, Mather, Calif
| | - Ankur Gupta
- Department of Research, Sacramento Veterans Affairs Medical Center, Mather, Calif
| | - Richard C Anderson
- Department of Research, Sacramento Veterans Affairs Medical Center, Mather, Calif
| | - Zachary T Irwin
- Department of Research, Sacramento Veterans Affairs Medical Center, Mather, Calif
| | - Elise A Newton
- Department of Research, Sacramento Veterans Affairs Medical Center, Mather, Calif
| | - Natalia Jaime-Hughes
- Department of Research, Sacramento Veterans Affairs Medical Center, Mather, Calif
| | - Sandipan Datta
- Department of Research, Sacramento Veterans Affairs Medical Center, Mather, Calif; Department of Molecular Bioscience, School of Veterinary Medicine, University of California, Davis, Calif
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12
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Zhao W, Wang G, Xu P, Wu T, Chen B, Ren H, Li X. Analysis of High-Risk Factors Associated with the Progression of Subaneurysmal Aorta to Abdominal Aortic Aneurysm in Rural Area in China. Clin Interv Aging 2021; 16:1573-1580. [PMID: 34465986 PMCID: PMC8402982 DOI: 10.2147/cia.s321921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/04/2021] [Indexed: 11/24/2022] Open
Abstract
Objective To determine the risk factors associated with the progress of subaneurysmal aorta (SAA) to abdominal aortic aneurysm (AAA) and provide a reference for the prevention of AAA in rural areas. Methods A total of 747 SAA patients screened by the Health Management Center of the Second Hospital of Lanzhou University from January 2015 to January 2016 were recruited. The ratio of SAA progressing to AAA was observed through 5 years of follow-up. Logistic stepwise regression analysis was performed to analyze the high-risk factors. The relevant clinical prediction model score table (Nom) was made and the C-index and calibration chart were used to verify the prediction ability of the model. Results Of the 747 patients diagnosed with SAA, 260 developed to AAA, with an incidence of 34.8%. Univariate analysis showed that age (62–65 years old), abdominal aorta diameter greater than 2.7 cm, smoking after 30 years old, moderate to severe hypertension, and blood pressure variability were the important high-risk factors of SAA progressing to AAA. Logistic regression analysis showed that these factors were statistically significant. The nomogram of clinical prediction model score showed that when 50–60% of SAA developed to AAA, the score was 189–201 and the C-index was 0.883, verifying the moderate predictive ability of this model. Conclusion Age, smoking habit, degree of hypertension, and control situation were high-risk factors associated with the progression of SAA to AAA. The control of the above high-risk factors was imperative for the prevention of AAA in rural areas without sufficient medical resources.
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Affiliation(s)
- Wenjun Zhao
- Department of Ultrasound, Imaging, Healthy Management Centre, The Second Hospital of Lanzhou University, Lanzhou City, 730000, Gansu Province, People's Republic of China
| | - Gang Wang
- Department of Neurosurgeon, Neurology, Neurologist, The Second Hospital of Lanzhou University, Lanzhou City, 730000, Gansu Province, People's Republic of China
| | - Ping Xu
- Department of Ultrasound, Imaging, Ultrasound Centre, The Second Hospital of Lanzhou University, Lanzhou City, 730000, Gansu Province, People's Republic of China
| | - Tingting Wu
- Department of Ultrasound, Imaging, Ultrasound Centre, The Second Hospital of Lanzhou University, Lanzhou City, 730000, Gansu Province, People's Republic of China
| | - Binjuan Chen
- Department of Ultrasound, Imaging, Ultrasound Centre, The Second Hospital of Lanzhou University, Lanzhou City, 730000, Gansu Province, People's Republic of China
| | - Haijun Ren
- Department of Neurosurgeon, Neurology, Neurologist, The Second Hospital of Lanzhou University, Lanzhou City, 730000, Gansu Province, People's Republic of China
| | - Xingjie Li
- Department of Ultrasound, Imaging, Healthy Management Centre, The Second Hospital of Lanzhou University, Lanzhou City, 730000, Gansu Province, People's Republic of China
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13
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Høgh J, Pham MHC, Knudsen AD, Thudium RF, Gelpi M, Sigvardsen PE, Fuchs A, Kühl JT, Afzal S, Nordestgaard BG, Benfield T, Køber L, Gerstoft J, Kofoed KF, Nielsen SD. HIV infection is associated with thoracic and abdominal aortic aneurysms: a prospective matched cohort study. Eur Heart J 2021; 42:2924-2931. [PMID: 34240121 DOI: 10.1093/eurheartj/ehab348] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/14/2021] [Accepted: 05/26/2021] [Indexed: 12/20/2022] Open
Abstract
AIMS Little is known about the prevalence of aortic aneurysms among people living with HIV (PLWH). We investigated whether HIV status is independently associated with having aortic aneurysms. Furthermore, we determined risk factors associated with aortic aneurysms in PLWH. METHODS AND RESULTS PLWH aged ≥40 years (n = 594) were recruited from the Copenhagen Comorbidity in HIV Infection study and matched for age and sex with uninfected controls (n = 1188) from the Copenhagen General Population Study. Aortic dimensions were assessed using contrast enhanced computed tomography. Aortic aneurysms were defined according to the European Society of Cardiology guidelines, i.e. an aortic dilation of ≥50% or an infrarenal aortic diameter of ≥30 mm. Among PLWH and uninfected controls, the median (interquartile range) age was 52 (47-60) and 52 (48-61) and 88% and 90% were male, respectively. We found 46 aneurysms in 42 (7.1%) PLWH and 31 aneurysms in 29 (2.4%) uninfected controls (P < 0.001). PLWH had a significantly higher prevalence of ascending aortic aneurysms and infrarenal aortic aneurysms. In an adjusted model, HIV was independently associated with aortic aneurysms (adjusted odds ratio; 4.51 [95% confidence interval 2.56-8.08], P < 0.001). Within PLWH, obesity and hepatitis B co-infection were associated with aortic aneurysms. CONCLUSION PLWH had four-fold higher odds of aortic aneurysms compared to uninfected controls, and HIV status was independently associated with aortic aneurysms. Among PLWH, age, obesity and hepatitis B co-infection were associated with higher odds of aortic aneurysms. Our findings suggest that increased attention to aortic aneurysms in PLWH may be beneficial.
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Affiliation(s)
- Julie Høgh
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Esther Møllers Vej 6, 2100 Kbh Ø, Copenhagen, Denmark
| | - Michael Huy Cuong Pham
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark
| | - Andreas Dehlbæk Knudsen
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Esther Møllers Vej 6, 2100 Kbh Ø, Copenhagen, Denmark.,Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark
| | - Rebekka Faber Thudium
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Esther Møllers Vej 6, 2100 Kbh Ø, Copenhagen, Denmark
| | - Marco Gelpi
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Esther Møllers Vej 6, 2100 Kbh Ø, Copenhagen, Denmark
| | - Per Ejlstrup Sigvardsen
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark
| | - Andreas Fuchs
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark
| | - Jørgen Tobias Kühl
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark
| | - Shoaib Afzal
- The Copenhagen General Population Study, Department of Clinical Biochemistry, Herlev Gentofte Hospital, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
| | - Børge Grønne Nordestgaard
- The Copenhagen General Population Study, Department of Clinical Biochemistry, Herlev Gentofte Hospital, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Kbh N, Copenhagen, Denmark
| | - Thomas Benfield
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Kbh N, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital, Amager Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Kbh N, Copenhagen, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Esther Møllers Vej 6, 2100 Kbh Ø, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Kbh N, Copenhagen, Denmark
| | - Klaus Fuglsang Kofoed
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Kbh N, Copenhagen, Denmark.,Department of Radiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Esther Møllers Vej 6, 2100 Kbh Ø, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Kbh N, Copenhagen, Denmark
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14
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Fadel BM, Mohty D, Kazzi BE, Alamro B, Arshi F, Mustafa M, Echahidi N, Aboyans V. Ultrasound Imaging of the Abdominal Aorta: A Comprehensive Review. J Am Soc Echocardiogr 2021; 34:1119-1136. [PMID: 34224827 DOI: 10.1016/j.echo.2021.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/10/2021] [Accepted: 06/10/2021] [Indexed: 11/28/2022]
Abstract
Ultrasound is the imaging modality of choice for the initial evaluation of disorders that involve the abdominal aorta (AA). The diagnostic value of ultrasound resides in its ability to allow assessment of the anatomy and structure of the AA using two- dimensional, three-dimensional, and contrast-enhanced imaging. Moreover, ultrasound permits evaluation of the physiologic and hemodynamic consequences of abnormalities through Doppler interrogation of blood flow, thus enabling the identification and quantification of disorders within the AA and beyond its boundaries. The approach to ultrasound imaging of the AA varies, depending on the purpose of the study and whether it is performed in a radiology or vascular laboratory or in an echocardiography laboratory. The aim of this review is to demonstrate the usefulness of ultrasound imaging for the detection and evaluation of disorders that involve the AA, detail the abnormalities that are detected or further assessed, and outline its value for echocardiographers, sonographers, and radiologists.
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Affiliation(s)
- Bahaa M Fadel
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; Alfaisal University, Riyadh, Saudi Arabia.
| | - Dania Mohty
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; Alfaisal University, Riyadh, Saudi Arabia; Department of Cardiology, Dupuytren-2 University Hospital, and Inserm 1094 & IRD, Limoges University, Limoges, France
| | | | - Bandar Alamro
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; Alfaisal University, Riyadh, Saudi Arabia
| | - Fatima Arshi
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Manal Mustafa
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Najmeddine Echahidi
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; Department of Cardiology, Dupuytren-2 University Hospital, and Inserm 1094 & IRD, Limoges University, Limoges, France
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, and Inserm 1094 & IRD, Limoges University, Limoges, France
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15
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Adventitial recruitment of Lyve-1- macrophages drives aortic aneurysm in an angiotensin-2-based murine model. Clin Sci (Lond) 2021; 135:1295-1309. [PMID: 33978148 DOI: 10.1042/cs20200963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 04/30/2021] [Accepted: 05/12/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Aortic macrophage accumulation is characteristic of the pathogenesis of abdominal aortic aneurysm (AAA) but the mechanisms of macrophage accumulation and their phenotype are poorly understood. Lymphatic vessel endothelial receptor-1 (Lyve-1+) resident aortic macrophages independently self-renew and are functionally distinct from monocyte-derived macrophages recruited during inflammation. We hypothesized that Lyve-1+ and Lyve-1- macrophages differentially contribute to aortic aneurysm. Approach and results: Angiotensin-2 and β-aminopropionitrile (AT2/BAPN) were administered to induce AAA in C57BL/6J mice. Using immunohistochemistry (IHC), we demonstrated primarily adventitial accumulation of aortic macrophages, and in association with areas of elastin fragmentation and aortic dissection. Compared with controls, AAA was associated with a relative percent depletion of Lyve-1+ resident aortic macrophages and accumulation of Lyve-1- macrophages. Using CD45.1/CD45.2 parabiosis, we demonstrated aortic macrophage recruitment in AAA. Depletion of aortic macrophages in CCR2-/- mice was associated with reduced aortic dilatation indicating the functional role of recruitment from the bone marrow. Depletion of aortic macrophages using anti-macrophage colony-stimulating factor 1 receptor (MCSF1R)-neutralizing antibody (Ab) reduced the incidence of AAA. Conditional depletion of Lyve-1+ aortic macrophages was achieved by generating Lyve-1wt/cre Csf1rfl/fl mice. Selective depletion of Lyve-1+ aortic macrophages had no protective effects following AT2/BAPN administration and resulted in increased aortic dilatation in the suprarenal aorta. CONCLUSIONS Aortic macrophage accumulation in AAA derives from adventitial recruitment of Lyve-1- macrophages, with relative percent depletion of Lyve-1+ macrophages. Selective targeting of macrophage subtypes represents a potential novel therapeutic avenue for the medical treatment of AAA.
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16
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Effect of Doxycycline on Survival in Abdominal Aortic Aneurysms in a Mouse Model. CONTRAST MEDIA & MOLECULAR IMAGING 2021; 2021:9999847. [PMID: 34007253 PMCID: PMC8099506 DOI: 10.1155/2021/9999847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/12/2021] [Accepted: 04/19/2021] [Indexed: 11/18/2022]
Abstract
Background Currently, there is no reliable nonsurgical treatment for abdominal aortic aneurysm (AAA). This study, therefore, investigates if doxycycline reduces AAA growth and the number of rupture-related deaths in a murine ApoE-/- model of AAA and whether gadofosveset trisodium-based MRI differs between animals with and without doxycycline treatment. Methods Nine ApoE-/- mice were implanted with osmotic minipumps continuously releasing angiotensin II and treated with doxycycline (30 mg/kg/d) in parallel. After four weeks, MRI was performed at 3T with a clinical dose of the albumin-binding probe gadofosveset (0.03 mmol/kg). Results were compared with previously published wild-type control animals and with previously studied ApoE-/- animals without doxycycline treatment. Differences in mortality were also investigated between these groups. Results In a previous study, we found that approximately 25% of angiotensin II-infused ApoE-/- mice died, whereas in the present study, only one out of 9 angiotensin II-infused and doxycycline-treated ApoE-/- mice (11.1%) died within 4 weeks. Furthermore, doxycycline-treated ApoE-/- mice showed significantly lower contrast-to-noise (CNR) values (p=0.017) in MRI compared to ApoE-/- mice without doxycycline treatment. In vivo measurements of relative signal enhancement (CNR) correlated significantly with ex vivo measurements of albumin staining (R 2 = 0.58). In addition, a strong visual colocalization of albumin-positive areas in the fluorescence albumin staining with gadolinium distribution in LA-ICP-MS was shown. However, no significant difference in aneurysm size was observed after doxycycline treatment. Conclusion The present experimental in vivo study suggests that doxycycline treatment may reduce rupture-related deaths in AAA by slowing endothelial damage without reversing aneurysm growth.
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17
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FitÉ J, Gimenez E, Soto B, Artigas V, Escudero JR, Bellmunt-Montoya S, Espallargues M. Systematic review on abdominal aortic aneurysm screening cost-efficiency and methodological quality assessment. INT ANGIOL 2020; 40:67-76. [PMID: 33086780 DOI: 10.23736/s0392-9590.20.04547-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Abdominal aortic aneurysm (AAA) is a silent, progressive disease that can lead to death. It is easily diagnosed with noninvasive methods and its routine treatment has excellent results. This creates an optimal situation for population screening programs. The aim of this paper was to assess results and methodological quality of cost-utility studies on screening versus no screening scenarios for AAA to assess future establishment of new AAA screening programs. EVIDENCE ACQUISITON A systematic review of efficiency (cost-effectiveness and cost-utility) studies was performed, finally selecting cost-utility studies on AAA screening versus no screening. Papers were selected that dealt with efficiency of screening for AAA according to PICOTS framework and the methodological quality assessed according to the economic evaluation analyses described by Drummond and Caro. Two independent reviewers were involved in the procedure. EVIDENCE SYNTHESIS Research retrieved 88 studies. From those, 26 showed cost-effectiveness and cost-utility results. Finally, 10 studies had cost-utility results and suited criteria (published in the last 10 years; time-horizon: 10 years or more) for exhaustive analysis. All publications, except one, showed adequate incremental cost-utility ratios according to different national perspectives. Methodological assessment showed some quality limitations, but the majority of items analyzed were favorably answered after applying the questionnaires. CONCLUSIONS Confirmation of the cost-utility results in this revision at a national/regional level should be the basis for the implantation of new national screening programs worldwide. The methodological evaluation applied in this revision is crucial for the corresponding future piggy-back trials to assess routine application of national AAA screening programs.
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Affiliation(s)
- Joan FitÉ
- Centro de Investigación Biomédica en Red (CIBER) Cardiovascular, Department of Vascular Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain.,Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Emmanuel Gimenez
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Generalitat de Catalunya, Barcelona, Spain
| | - Begoña Soto
- Centro de Investigación Biomédica en Red (CIBER) Cardiovascular, Department of Vascular Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain.,Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Vicente Artigas
- Centro de Investigación Biomédica en Red (CIBER) Cardiovascular, Department of Vascular Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain.,Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Jose R Escudero
- Centro de Investigación Biomédica en Red (CIBER) Cardiovascular, Department of Vascular Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain.,Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Sergi Bellmunt-Montoya
- Universitat Autónoma de Barcelona, Barcelona, Spain - .,Department of Vascular Surgery, Hospital Universitari Vall d'Hebron, University of Barcelona, Barcelona, Spain
| | - Mireia Espallargues
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Generalitat de Catalunya, Barcelona, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barcelona, Spain
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18
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Cho JH, Han KD, Jung HY, Bond A. National health screening may reduce cardiovascular morbidity and mortality among the elderly. Public Health 2020; 187:172-176. [PMID: 32992163 DOI: 10.1016/j.puhe.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/04/2020] [Accepted: 08/09/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Since 2007, the Korean government has provided a free health screening to the elderly starting at the age of 66 years. The purpose of this study was to evaluate the association between this general health screening and the incidences of stroke and myocardial infarction and mortality. STUDY DESIGN The study design used in this study is a retrospective cohort study. METHODS The study was conducted using the universe of insurance claims data of Korea and followed a cohort of individuals aged 66 years in 2009 from 2006 through 2016 (n = 354,194). We assessed the association between receipt of the national health screening and health outcomes using propensity matching and Cox proportional hazard models. RESULTS We found that the receipt of the national health screening was associated with a reduction in negative health outcomes. The hazard ratio for stroke was 0.89 (P < 0.001), 0.88 (P < 0.001) for myocardial infarction and 0.58 for death (P < 0.001). CONCLUSION Korea's national health screening was associated with reductions in cardiovascular morbidity and mortality in the elderly.
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Affiliation(s)
- J H Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konkuk University, Seoul, Republic of Korea.
| | - K D Han
- Department of Biostatistics, Catholic University College of Medicine, Seoul, Republic of Korea
| | - H-Y Jung
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - A Bond
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
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19
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Association Between the Atherosclerotic Disease Risk Score and Carotid Artery Stenosis. J Surg Res 2020; 257:189-194. [PMID: 32835952 DOI: 10.1016/j.jss.2020.06.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 05/07/2020] [Accepted: 06/16/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Carotid artery stenosis (CAS) is the most frequently detected treatable cause of ischemic stroke. However, there are no recommendations to screen asymptomatic patients. The atherosclerotic cardiovascular disease (ASCVD) risk score estimates individuals' 10-year risk for developing cardiovascular disease. The objective of this study is to identify a relationship between the ASCVD risk score and moderate/severe CAS based on ultrasound findings. MATERIALS AND METHODS We performed a single-institution retrospective review of patients who underwent a surveillance ultrasound for CAS between 2015 and 2018. We used Strandness velocity criteria to separate patients into two cohorts: none to mild CAS (<50%) and moderate/severe CAS (≥50%). We performed Student's t-test, multivariate analysis, and receiver operator characteristic (ROC) curve analysis to determine a relationship between the ASCVD risk score and degree of CAS. We evaluated a new risk score model based on stepwise logistic regression of significant variables on univariate analysis. RESULTS Two thousand eight hundred and fifty-six patients with carotid ultrasounds (1623 with none to mild, 1161 with moderate, and 72 with severe disease) were included in the study. The ASCVD risk score significantly predicted moderate/severe CAS in an adjusted multivariate analysis. Each 10% increase in the ASCVD risk score corresponded to an additional 11% likelihood of moderate/severe stenosis (OR: 1.11 [1.04-1.20], P = 0.004). The ROC area under the curve for predicting moderate/severe CAS based on the ASCVD risk score was 0.59 (Youden index (J) = 0.14); the optimized ASCVD cutoff point was 28.4%. Our new atherosclerotic disease model demonstrated increased odds of moderate/severe CAS with scores greater than zero (ROC area under the curve = 0.57). CONCLUSIONS This is the first study to demonstrate an association between atherosclerotic disease risk factors as measured by the ASCVD risk score and moderate/severe CAS. However, this tool is not sensitive or specific for using the ASCVD risk score as a screening mechanism for moderate/severe CAS.
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20
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Saw ST, Leong BDK, Abdul Aziz DA. Early Detection of Undiagnosed Abdominal Aortic Aneurysm and Sub-Aneurysmal Aortic Dilatations in Patients with High-Risk Coronary Artery Disease: The Value of Targetted Screening Programme. Vasc Health Risk Manag 2020; 16:215-229. [PMID: 32606718 PMCID: PMC7293413 DOI: 10.2147/vhrm.s250735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/26/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Abdominal aortic aneurysm (AAA) and coronary artery disease (CAD) share common risk factors. The objective of this study was to determine the prevalence of undiagnosed AAA in patients with angiographically diagnosed significant CAD. PATIENTS AND METHODS Male patients aged 50 years and above (including indigenous people) with angiographically diagnosed significant CAD in the recent one year were screened for AAA. Standard definition of abdominal aortic aneurysm and CAD was used. All new patients were followed up for six months for AAA events (ruptured AAA and AAA-related mortality). RESULTS A total of 277 male patients were recruited into this study. The total prevalence of undiagnosed AAA in this study population was 1.1% (95% CI 0.2-3.1). In patients with high-risk CAD, the prevalence of undiagnosed AAA was 1.7% (95% CI 0.3-4.8). The detected aneurysms ranged in size from 35.0mm to 63.8mm. Obesity was a common factor in these patients. There were no AAA-related mortality or morbidity during the follow-up. Although the total prevalence of undiagnosed AAA is low in the studied population, the prevalence of sub-aneurysmal aortic dilatation in patients with significant CAD was high at 6.6% (95% CI 3.9-10.2), in which majority were within the younger age group than 65 years old. CONCLUSION This was the first study on the prevalence of undiagnosed AAA in a significant CAD population involving indigenous people in the island of Borneo. Targeted screening of patients with high-risk CAD even though they are younger than 65 years old effectively discover potentially harmful asymptomatic AAA and sub-aneurysmal aortic dilatations.
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Affiliation(s)
- Siong Teng Saw
- Faculty of Medicine, Universiti Kebangsaan Malaysia; Hospital Queen Elizabeth II, Kota Kinabalu, Sabah88300, Malaysia
| | | | - Dayang Anita Abdul Aziz
- Faculty of Medicine, Universiti Kebangsaan Malaysia, UKM Medical Center, Kuala Lumpur56000, Malaysia
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Nationwide Analysis of Ruptured Abdominal Aortic Aneurysm in Portugal (2000-2015). Eur J Vasc Endovasc Surg 2020; 60:27-35. [PMID: 32307303 DOI: 10.1016/j.ejvs.2020.02.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/05/2020] [Accepted: 02/28/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Ruptured abdominal aortic aneurysm (rAAA) is a lethal condition that requires acute repair to prevent death. This analysis aims to assess the nationwide trends in rAAA admission, repair and mortality in a country, Portugal, without national screening for AAA. METHODS rAAA registered in the hospital administrative database of the National Health Service and all nationally registered deaths due to rAAA based on death certificate data were analysed. Three time periods (2000-2004, 2005-2009, and 2010-2015) were compared in patients ≥ 50 years old to assess the variations over time. RESULTS A total of 2 275 patients ≥50 years old with rAAA were identified in the two databases from 2000 to 2015. The age standardised incidence of rAAA was 2.78 ± 0.24/100 000/year in 2000-2004, 3.17 ± 0.39/100 000/year in 2005-2009 and 3.21 ± 0.28/100 000/year in 2010-2015 (p < .001). When comparing the time periods 2000-2004 to 2005-2009, the age standardised rate of admission (n = 1460) increased from 1.57 ± 0.25/100 000/year to 2.24 ± 0.32/100 000/year (p < .001). The operative mortality rates decreased during this time period (from 55.3 ± 4.7% to 48.8 ± 4.7%, p < .001). In 2010-2015, the age standardised rate of admissions due to rAAA decreased (1.98 ± 0.22/100 000/year). Operative mortality remained stable (48.9 ± 6.2%). The rate of patient deaths outside the hospital decreased from the first to the second period (1.21 ± 0.10/100 000/year and 0.93 ± 0.29/100 000/year, respectively) but later increased (1.14 ± 0.22/100 000/year). This resulted in a higher overall rAAA related mortality in Portugal in the third period (2.20 ± 0.18/100 000/year, 2.21 ± 0.27/100 000/year and 2.26 ± 0.26/100 000/year in 2000-2004, 2005-2009, and 2010-2015, respectively, p < .001). CONCLUSION Overall, the incidence of rAAA in Portugal has been stable over the past 10 years. The rates of admission, repair, and death due to rAAA repair seem to have reached an inflection point and are now decreasing. Mortality outside the hospital remains a matter of concern, warranting further planning of streamlined transfer networks and vascular surgical departments.
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Ultrasound Surveillance of Common Iliac Artery Aneurysms. Ann Vasc Surg 2019; 65:166-173. [PMID: 31669342 DOI: 10.1016/j.avsg.2019.10.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/09/2019] [Accepted: 10/09/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND The surveillance of patients with common iliac artery aneurysms (CIAA) does not follow a defined protocol such as the one adopted for the management of abdominal aortic aneurysms. This study explores CIAA growth rate, and seeks to determine correlations with related parameters which may serve to influence aneurysm expansion with the view of devising an effective local surveillance protocol. METHODS Vascular laboratories across the UK were invited to participate in an online survey. Questions were designed to assess current clinical practice in regards to the surveillance of patients with CIAA. Additionally, a retrospective audit was performed using the clinical reports of patients attending a regional vascular laboratory to undergo an aorto-iliac duplex scan (USS). Expansion rate of aneurysms was studied in patients who had ≥2 USS scans; data was recorded at 6 and/or 12 monthly intervals up to 5 years. Kaplan Meier estimates of patient mortality (all cause) and intervention rate during the surveillance period were performed. Patient age, initial CIAA diameter, bilateral/unilateral CIAA and coinciding aortic aneurysm diameter were recorded to determine if these specific features were associated with CIAA growth rates. Pearson's correlation coefficient was used to determine the strength of association between variables. RESULTS Nine hundred and ninety-five of one thousand and sixty patient records were suitable for review: 21.6% (215/995) of patients had a CIAA. Isolated CIAA accounted for 23% (50/215). Mean CIAA growth was 1.5 ± 0.3 mm/year. A strong correlation was found between CIAA diameter versus time from diagnosis (r = 0.820; P = 0.004); CIAA with smaller initial diameters (15-20 mm) expanded more rapidly than those of larger diameter at diagnosis (r = 0.871; P = 0.005). CIAA measured at >30 mm demonstrated an unpredictable growth trajectory which was also evident in those CIAA coinciding with larger AAA (>50 mm; r = 0.208; P = 0.655). CONCLUSIONS The results obtained in this study may form the basis for a dedicated CIAA surveillance protocol.
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Molacek J, Treska V, Zeithaml J, Hollan I, Topolcan O, Pecen L, Slouka D, Karlikova M, Kucera R. Blood biomarker panel recommended for personalized prediction, prognosis, and prevention of complications associated with abdominal aortic aneurysm. EPMA J 2019; 10:125-135. [PMID: 31258818 PMCID: PMC6562056 DOI: 10.1007/s13167-019-00173-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/12/2019] [Accepted: 05/15/2019] [Indexed: 12/22/2022]
Abstract
The aim of the study was to evaluate the ability of following biomarkers as diagnostic tools and risk predictors of AAA: C-reactive protein, interleukin-6, pentraxin-3, galectin-3, procollagen type III N-terminal peptide, C-terminal telopeptide of type I collagen, high-sensitive troponin I, and brain natriuretic peptide. Seventy-two patients with an AAA and 100 healthy individuals were enrolled into the study. We assessed individual biomarker performance and correlation between the AAA diameter and biomarker levels, and also, a multivariate logistic regression was used to design a possible predictive model of AAA growth and rupture risk. We identified following four parameters with the highest potential to find a useful place in AAA diagnostics: galectin-3, pentraxin-3, interleukin-6, and C-terminal telopeptide of type I. The best biomarkers in our evaluation (galectin-3 and pentraxin-3) were AAA diameter-independent. With the high AUC and AAA diameter correlation, the high-sensitive troponin I can be used as an independent prognostic biomarker of the upcoming heart complications in AAA patients. Authors recommend to add biomarkers as additional parameters to the current AAA patient management. Main addition value of biomarkers is in the assessment of the AAA with the smaller diameter. Elevated biomarkers can change the treatment decision, which would be done only based on AAA diameter size. The best way how to manage the AAA patients is to create a reliable predictive model of AAA growth and rupture risk. A created multiparameter model gives very promising results with the significantly higher efficiency compared with the use of the individual biomarkers.
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Affiliation(s)
- Jiri Molacek
- Department of Surgery, University Hospital and Faculty of Medicine in Pilsen, Pilsen, Czech Republic
| | - Vladislav Treska
- Department of Surgery, University Hospital and Faculty of Medicine in Pilsen, Pilsen, Czech Republic
| | - Jan Zeithaml
- Department of Surgery, University Hospital and Faculty of Medicine in Pilsen, Pilsen, Czech Republic
| | - Ivana Hollan
- Department of Rheumatology, Hospital for Rheumatic Diseases, 2609 Lillehammer, Norway
- Department of Research, Innlandet Hospital Trust, Brumunddal, Norway
- Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Ondrej Topolcan
- Department of Immunochemistry Diagnostics, University Hospital and Faculty of Medicine in Pilsen, Pilsen, Czech Republic
| | - Ladislav Pecen
- Department of Immunochemistry Diagnostics, University Hospital and Faculty of Medicine in Pilsen, Pilsen, Czech Republic
| | - David Slouka
- Department of Immunochemistry Diagnostics, University Hospital and Faculty of Medicine in Pilsen, Pilsen, Czech Republic
| | - Marie Karlikova
- Department of Immunochemistry Diagnostics, University Hospital and Faculty of Medicine in Pilsen, Pilsen, Czech Republic
| | - Radek Kucera
- Department of Immunochemistry Diagnostics, University Hospital and Faculty of Medicine in Pilsen, Pilsen, Czech Republic
- Department of Immunochemistry Diagnostics, University Hospital Pilsen, Dr. E. Benese 1128/13, 305 99 Pilsen, Czech Republic
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