Determinants of Aneurysmal Aortic Disease

Abdominal aortic aneurysm (AAA) imposes a burden of epidemic proportions. Screening programs in the United States and in Europe have shown that 5% of men >65 years of age have an occult AAA,1 and therefore, an understanding of the determinants of AAA is essential to the design of effective interventions. The article by Forsdahl and colleagues2 in this issue of Circulation specifically addresses this important issue in a cohort of 4345 men and women in Tromso, Norway. The authors report that male sex, increasing age, and smoking are prominent risk factors for incident AAA in the next 7 years. This is consistent with previously reported studies, which provides reassurance regarding the robustness of the data.3–7 Epidemiological screening studies also suggest a strong association of AAA with atherosclerosis, coronary artery disease, and peripheral arterial disease. The aortic diameter in individuals with AAA detected by screening is rarely of a size associated with a short-term risk for aneurysm-related death (ie, rupture) but rather with a …