Women who smoke may be at higher risk of developing abdominal aortic aneurysm (AAA) compared with men who do not smoke, according to study results published in the Journal of the American Heart Association.

AAA screening programs in the United States (US) and the United Kingdom (UK) have been associated with reductions in the rates of AAA-related mortality. Previous studies in which the risk factors for AAA were examined, had small cohorts which included individuals with comorbidities or a history of cardiovascular disease. The objective of this study was to estimate the gender-specific prevalence of AAA and evaluate the strength of associations between vascular risk factors and AAA using a screening survey of 2.3 million men and women without an AAA diagnosis or a history of cardiovascular disease.

In this cross-sectional study, the data of 1.5 million women and 0.8 million men (ages, 35-89 years) without known vascular disease were evaluated. Study participants presented to commercial screening clinics in the US or UK between 2008 and 2013. AAA was defined as a maximum infrarenal aortic diameter ≥3 cm. Multivariable logistic regression was used to evaluate the implication of traditional vascular risk factors in the development of AAA.The prevalence of AAA was 0.6% (n=12,729; 95% CI: 0.54-0.56) in this cohort. The prevalence of AAA was significantly higher in smokers vs nonsmokers for every age group. Among women who smoked, AAA prevalence increased from 0.9% in those aged 60 to 69 years, to 4.1% in those ≥80 years, and was higher in women who smoked compared with men who never smoked across all age groups. The risk for AAA in current vs never smokers was 7 times greater for men (relative risk [RR], 7.3; 95% CI, 6.4-8.2), and 15 times greater for women (RR, 15.0; 95% CI, 13.2-17.0). In women <75 years who smoked, the AAA risk was nearly 30 times greater than that of their never-smoker counterparts (RR, 26.4; 95% CI, 20.3-34.2). Positive associations were established between AAA and usual body mass index, height, usual systolic blood pressure, usual low-density lipoprotein cholesterol, and usual triglycerides for both sexes.

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Study limitations include the self-reporting of cardiovascular disease history and medication use, the possibility of residual confounding, and the self-referral of patients for screening.

“[W]hilst [women who smoke] are at lower absolute risk of AAA than [men who smoke], at any given age, [women who smoke] are at higher risk [for] AAA than men never-smokers. A policy of screening low-risk never-smoker men, but not higher risk women smokers is therefore questionable,” concluded the study authors.


Carter JL, Morris DR, Sherliker P, et al. Sex‐specific associations of vascular risk factors with abdominal aortic aneurysm: findings from 1.5 million women and 0.8 million men in the United States and United Kingdom [published online February 18, 2020]. J Am Heart Assoc. doi: 10.1161/JAHA.119.014748