For Older Male Smokers, Aortic Aneurysm Check Urged

Abdominal aortic aneurysm screening recommended for men over 65 who have smoked

(RxWiki News) Smoking poses many health risks, including that of abdominal aortic aneurysm, which can lead to rupture. Men who have ever smoked are especially at risk and advised to be screened for the condition.

With abdominal aortic aneurysm, the main blood vessel that supplies blood to the abdomen, pelvis and legs widens or balloons to about an inch wide or greater due to weakness in the vessel wall. If the aorta ruptures, it can cause massive internal bleeding and be fatal. The condition can develop slowly over many years without any symptoms.

The U.S. Preventive Services Task Force (USPSTF) has issued a statement recommending one-time screening for men aged 65 to 75 who have ever smoked and selective screening for men in this age group who have never smoked.

"Quit smoking to reduce risk of abdominal aortic aneurysm."

Michael L. LeFevre, MD, with the University of Missouri School of Medicine in Columbia, Missouri, served as chair of the USPSTF in Rockville, Maryland.

Based on evidence from four large studies, Dr. LeFevre and his colleagues found that one-time screening for abdominal aortic aneurysm with ultrasonography in older men who have smoked was linked to a reduced risk of death, rupture and emergency surgery. According to two of the investigations, death related to abdominal aortic aneurysm after 13 years dropped by 42 to 66 percent because of ultrasonography screening.

Ultrasonography is a diagnostic imaging technique that uses high frequency sound waves to produce images of internal body structures.

USPSTF members reported that these aneurysms are most common among men who have ever smoked, with 6 to 7 percent of this population having the condition. An “ever smoker” is often defined as having consumed 100 or more cigarettes.

"Occasional tobacco use for a short time in the past (for example, occasional 'social' smoking as an adolescent or young adult) is unlikely to have a pronounced biological effect," the task force wrote.

"However, observational studies have found that even a relatively modest smoking history (for example, smoking a half-pack or less per day for fewer than 10 years) does increase the likelihood of developing a large abdominal aortic aneurysm," they wrote.

The Task Force also called for selective screening of abdominal aortic aneurysm in men aged 65 to 75 years who have never smoked. This recommendation was based on a review of benefits and harms for the individual and risk factors other than smoking, such as advanced age, male sex, family history and history of other vascular aneurysms, coronary artery disease, cerebrovascular disease, atherosclerosis, high cholesterol, obesity, diabetes or high blood pressure. African American race and Hispanic ethnicity may also increase the likelihood of abdominal aortic aneurysm.

With regard to women, the USPSTF found insufficient evidence in favor or against screening in women aged 65 to 75 years who have ever smoked. The researchers did recommend, however, that women who have never smoked not have routine screening for abdominal aortic aneurysm.

Overall, an estimated 3.9 to 7.2 percent of men and 1 to 1.3 percent of women aged 50 years or older have abdominal aortic aneurysm, according to researchers.

"Alternative strategies to reduce [abdominal aortic aneurysm] growth, such as antibiotics, statins, or other novel pharmacologic agents, need to be further explored," the Task Force wrote. "Interventions to address modifiable risk factors (particularly smoking) may be worth considering. Effective strategies for smoking cessation may improve the care of patients with small [abdominal aortic aneurysms].”

The recommendation statement was published June 23 in the Annals of Internal Medicine.

Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services. USPSTF member Douglas K. Owens, MD, of the Freeman Spogli Institute for International Studies, Stanford University in California, received support from the Agency for Healthcare Research and Quality during this study.

Review Date: 
June 23, 2014