Cardiovascular risk in patients with small and medium abdominal aortic aneurysms, and no history of cardiovascular disease

Background Cardiovascular disease ( CVD ) is the main cause of death in people with abdominal aortic aneurysm ( AAA ). There is little evidence that screening for AAA reduces all‐cause or cardiovascular mortality. The aim of the study was to assess whether subjects with a small or medium AAA (3·0–5·4 cm), without previous history of clinical CVD, had raised levels of CVD biomarkers or increased total mortality. Methods This prospective study included subjects with a small or medium AAA and controls, all without a history of clinical CVD . CVD biomarkers (high‐sensitivity C‐reactive protein, hs‐ CRP ; heart‐type fatty acid‐binding protein, H‐ FABP ) were measured, and survival was recorded. Results Of a total of 815 people, 476 with an AAA and 339 controls, a cohort of 86 with small or medium AAA (3–5·4 cm) and 158 controls, all with no clinical history of CVD , were identified. The groups were matched for age and sex. The AAA group had higher median (i.q.r.) levels of hs‐ CRP (2·8 (1·2–6·0) versus 1·3 (0·5–3·5) mg/l; P  < 0·001) and H‐ FABP (4·6 (3·5–6·0) versus 4·0 (3·3–5·1) µg/l; P  = 0·011) than controls. Smoking was more common in the AAA group; however, hs‐ CRP and H‐ FABP levels were not related to smoking. Mean survival was lower in the AAA group: 6·3 (95 per cent confidence interval (c·i.) 5·6 to 6·9) years versus 8·0 (7·6 to 8·1) years in controls ( P  < 0·001). Adjusted mortality was higher in the AAA group (hazard ratio 3·41, 95 per cent c·i. 2·11 to 9·19; P  < 0·001). Conclusion People with small or medium AAA and no clinical symptoms of CVD have higher levels of hs‐ CRP and H‐ FABP , and higher mortality compared with controls. They should continue to receive secondary prevention against CVD .