The Polymorphonuclear Leukocyte and the Abdominal Aortic Aneurysm

Companion reports in this issue of Circulation under the senior authorship of G.R. Upchurch1,2 address the possible roles of polymorphonuclear (PMN) cells in the pathogenesis of the nonspecific abdominal aortic aneurysm (AAA). As the authors observe, the AAA is the 10th leading cause of death in white men ages 65 to 74, according to the 2000 National Vital Statistics report, and there were 36 000 surgical repairs.See pp 232 and 241 A study has addressed the state of National Institutes of Health (NIH) funding for research on specific diseases in relation to their burden on public health.3 The 3 leading causes of mortality (ischemic heart disease, lung cancer, and stroke; with a cumulative estimated 4877 “years of life lost”) received ≈$500 million altogether in NIH research support in the year 1990. The 3 rank-ordered leaders in receipt in NIH funding (AIDS, breast cancer, and dementia; with a cumulative estimated 1504 “years of life lost”) received ≈$21 billion dollars in NIH research support. Among the 29 diseases rank-ordered by NIH support, the AAA was not present. In the history of NIH funding for AAA research, there has been only one request for proposals. It is not immediately obvious why research on the causes and prevention of AAA has been so neglected.Perhaps the reason is the deeply embedded notion that the AAA is simply a late degenerative phase of atherosclerosis. Recent editions of major textbooks on pathology4 and medicine5 still offer the “atherosclerotic” explanation for AAA causation. A student of the editorialist has traced references for this explanation back to a treatise by Scarpa, written in Italian and translated into English in 1808. Vascular clinicians know from observation that AAA, or for that matter, lesions that begin as poststenotic dilatations (eg, an aneurysm of the subclavian …