The Rise and Fall of Abdominal Aortic Aneurysm

In the current issue of Circulation , Svensjo et al1 report on an abdominal aortic aneurysm (AAA) screening program for 65-year-old men in central Sweden. Using the standard screening test (ultrasound) and AAA definition (an aortic diameter of 3.0 cm or larger), they found a prevalence of AAA of 1.7%, which they describe as “the lowest reported in a predominantly white population to this date,” and postulate that the explanation “may be an overall decrease of the disease in the population.” Two other recent studies have observed markedly decreased mortality from AAA in men in the past 2 decades in Western countries, with smaller decreases in women. Sandiford et al2 reported that AAA mortality in men dropped by more than half from 1991 to 2007 in New Zealand, and by a third from 1996 to 2007 in England and Wales; and Norman et al3 found a 38% decline in AAA mortality in men from 1999 to 2006 in Australia, adding that “this suggests a true fall in incidence of AAAs.”Article see p 1118These 3 studies may come as a surprise to those who remember a time not so long ago when AAA was a disease on the rise. The first alerts back then came from autopsy studies that charted an increasing occurrence of arteriosclerotic (many would now question this etiology) aortic aneurysms beginning in the late 1940s, just as syphilitic aneurysms went into decline.4 These observations were confirmed in a population-based study from Rochester, Minnesota, that found a marked increase in the incidence of AAA between 1951 and 1980 that seemed to reflect more than just improved case ascertainment.5 This …