Estudio de prevalencia de aneurisma de aorta abdominal en Atención Primaria

Aim

To describe the percentage of abdominal aortic aneurysm (AAA) cases in the Maspalomas Basic Health Zone among males aged 65 to 75 years who are current or former smokers. Our secondary objectives were to define the distribution of known risk factors for AAA development in our sample and to facilitate early referral to the appropriate vascular surgery service. We also aim to describe the percentage of subaneurysm cases, offering ultrasound follow-up at our center.

Design

This is a cross-sectional, descriptive, observational prevalence study.

Setting

Primary care level at the Maspalomas Health Center.

Participants

Men aged 65-75 years diagnosed as current or former smokers from the list requested from the computerized registration system of the Maspalomas Basic Health Zone. The sample size was 200 patients, and no attrition occurred, as the next patient on the list was selected if no response was received after 3 phone calls at different times or if exclusion criteria were met.

Main measurements

As main study variable, we collected the anteroposterior and transverse diameters of the abdominal aorta, as well as the longitudinal diameter in case of an aneurysm, according to the OTO criterion of placing the calliper in the area with the largest diameter. The presence or absence of atherosclerotic plaque (regardless of the finding of an aneurysm) and the morphology of the AAA, if present, were also recorded. Within the registry of data on affiliation and risk factors, we included: age, pack-year index, years as a smoker and years as an ex-smoker (less than 5 years, between 5 and 10 years, or more than 10 years). Other risk factors with a dichotomous «yes» or «no» response were: high blood pressure, diabetes mellitus, hypercholesterolemia, myocardial infarction, family history of abdominal aneurysm, personal history of aneurysm at another level, and presence of peripheral arterial disease, as well as the number of antihypertensive treatments.

Results

Among male smokers or former smokers aged 65 to 75 years in our sample, 14 cases of AAA were identified, of which 8 were already known. This corresponds to a prevalence of 7% (95% confidence interval: 4,2-11,4%). Additionally, 6,5% (95% CI: 3,8-10,8%) of the sample had a subaneurysmal aorta. Of the risk factors assessed, those with significant associations included a family history of AAA with a P value of 0,002, a personal history of aneurysm at another level with a P value of 0,010, symptoms of peripheral artery disease with a P value of 0,022, and after grouping aneurysms and subaneurysmal aortas, a history of peripheral artery disease with a P value of 0,033.

Conclusions

The prevalence of abdominal aortic aneurysm in our study among male smokers or former smokers was 7,0% (95% CI: 4,2-11,4%), and the prevalence of subaneurysmal aorta was 6,5% (95% CI: 3,8-10,8%), both higher than expected. These findings highlight the value of using ultrasound in primary care as part of a comprehensive and proactive approach to managing smokers and former smokers.