Oxford Vascular Study Calls for Updated National AAA Screening Policies

August 21, 2015—The American Heart Association (AHA) announced the publication of research showing that updated national screening policies could increase detection of abdominal aortic aneurysms  (AAAs) in older men. The study by Dominic P.J. Howard, DPhil, et al is available online ahead of print in the Journal of the American Heart Association.

Dr. Howard stated in the AHA announcement, “The current screening programs in the United Kingdom, United States, and Europe are a major step forward in treating AAA, but these strategies need to be adapted to the changing population that they serve. As people age and smoking rates decrease, strategies will need to be modified to remain effective.” Dr. Howard is a vascular surgeon at the University of Oxford in Oxford, United Kingdom.

The AHA noted that men who are 65 years and older are currently screened in the United States and Europe for AAA based on recommendations from the United States Preventive Services Task Force and European screening trials. However, deaths from AAA are increasing in older age groups.

The investigators reported that most ruptured aortic aneurysms now occur in people who are 75 years and older, and the number of those living longer than 75 years has doubled in the last 2 decades. Additionally, during the next few decades, the incidence of death due to AAA is likely to shift to those patients who are older than 85 years. The few ruptured aortic aneurysms that do occur in people who are 65 to 75 years of age occur almost exclusively in male smokers.

As reported by the AHA, the Oxford Vascular Study assessed 92,728 people for AAA from 2002 to 2014. The investigators calculated that modifying the national United Kingdom screening policy to screen only current male smokers at 65 years of age and all men at 75 years of age could prevent nearly four times the deaths and reduce the number of scans required by 20%.

A second key finding is recognition that this condition also occurs in older women, although screening has not been shown to benefit them. Women older than 75 years with risk factors such as high blood pressure should be considered for screening, but this would first require confirmation of a screening benefit in a randomized trial, advised the AHA.