V J Gokani1, D Sidloff2, M F Bath2, M J Bown2, R D Sayers2, E Choke2. 1. NIHR, Leicester Cardiovascular Biomedical Research Unit, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, LE3 9QP, United Kingdom. Electronic address: vimal.gokani@gmail.com. 2. NIHR, Leicester Cardiovascular Biomedical Research Unit, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, LE3 9QP, United Kingdom.
Abstract
INTRODUCTION: Literature regarding pharmacological manipulation of aneurysm development and progression is abundant; however studies looking at preventing rupture are sparse. Moreover, best medical therapy is ill-instituted, and continued in this high-risk cohort. This paper aims to identify factors which affect the risk of AAA-rupture. MATERIALS & METHODS: A retrospective review of patients undergoing non-screen detected AAA-repair at a single tertiary-referral centre was performed. Age, cardiovascular history, medication use and the nature of surgical repair (elective or emergency) were converted to binary characteristics and a binomial logistic regression performed. RESULTS: We included 315 admissions for ruptured AAA, and 668 referrals for elective repair of large aneurysms (n=983). Multifactorial analysis showed that the cohort which was prescribed statins experienced fewer ruptured AAA ([OR] 0.50, [95% CI] 0.32-0.77). Factors associated with increased risk of rupture include female gender (2.49, 1.63-3.80), history of hypertension (3.5, 1.6-3.8) or renal failure (8.08, 4.15-15.4), age over 80 (2.77, 1.79-4.27) and current smoking (1.80, 1.09-2.96). DISCUSSION AND CONCLUSIONS: This is the largest study, interrogating individual patient data, to suggest an association between statins and prevention of large AAA-rupture. As patients with AAA are at high risk of cardiovascular events, and statins may decrease the risk of the devastating consequence of the condition, healthcare teams should maintain pharmaco-vigilance in instituting and continuing best medical therapy, including a statin.
INTRODUCTION: Literature regarding pharmacological manipulation of aneurysm development and progression is abundant; however studies looking at preventing rupture are sparse. Moreover, best medical therapy is ill-instituted, and continued in this high-risk cohort. This paper aims to identify factors which affect the risk of AAA-rupture. MATERIALS & METHODS: A retrospective review of patients undergoing non-screen detected AAA-repair at a single tertiary-referral centre was performed. Age, cardiovascular history, medication use and the nature of surgical repair (elective or emergency) were converted to binary characteristics and a binomial logistic regression performed. RESULTS: We included 315 admissions for ruptured AAA, and 668 referrals for elective repair of large aneurysms (n=983). Multifactorial analysis showed that the cohort which was prescribed statins experienced fewer ruptured AAA ([OR] 0.50, [95% CI] 0.32-0.77). Factors associated with increased risk of rupture include female gender (2.49, 1.63-3.80), history of hypertension (3.5, 1.6-3.8) or renal failure (8.08, 4.15-15.4), age over 80 (2.77, 1.79-4.27) and current smoking (1.80, 1.09-2.96). DISCUSSION AND CONCLUSIONS: This is the largest study, interrogating individual patient data, to suggest an association between statins and prevention of large AAA-rupture. As patients with AAA are at high risk of cardiovascular events, and statins may decrease the risk of the devastating consequence of the condition, healthcare teams should maintain pharmaco-vigilance in instituting and continuing best medical therapy, including a statin.
Authors: Thomas Schmitz-Rixen; M Keese; M Hakimi; A Peters; D Böckler; K Nelson; R T Grundmann Journal: Langenbecks Arch Surg Date: 2016-03-21 Impact factor: 3.445
Authors: Aleksandra Piechota-Polanczyk; Alicja Jozkowicz; Witold Nowak; Wolf Eilenberg; Christoph Neumayer; Tadeusz Malinski; Ihor Huk; Christine Brostjan Journal: Front Cardiovasc Med Date: 2015-05-26
Authors: Konrad Salata; Muzammil Syed; Mohamad A Hussain; Charles de Mestral; Elisa Greco; Muhammad Mamdani; Jack V Tu; Thomas L Forbes; Deepak L Bhatt; Subodh Verma; Mohammed Al-Omran Journal: J Am Heart Assoc Date: 2018-10-02 Impact factor: 5.501