https://orcid.org/0000-0002-6577-0079
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Michael Huy Cuong Pham, Shoaib Afzal, Klaus Fuglsang Kofoed, Education and information to reduce aortic aneurysm mortality rates, European Heart Journal - Cardiovascular Imaging, Volume 25, Issue 10, October 2024, Page e250, https://doi.org/10.1093/ehjci/jeae208
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Extract
Thank you for the invitation to the discussion forum on important topics of aortic aneurysm (AA) epidemiology. We are delighted to contribute to the already comprehensive knowledge on AA, as elegantly described by Sterpetti and coauthors.1 In the last 4 decades, trajectories of mortality in Europe of this important disease has indeed developed differently in Northern vs. Central and Southern European countries. The explanations for these changes are likely multifactorial including, but not limited to socio-demographic index, general ageing of the populations, differences of health spending policy including prophylactic medical therapy, patient education, and lifestyle counselling.
The most likely prolonged subclinical phase of AA—that be either thoracic or abdominal—preceding the fatal manifestations of this disease, represents a time window which may allow for early detection and prevention. Screening for AAs, particularly abdominal AAs (AAA), may be beneficial for risk prevention of AAA-related mortality and rupture rates.2 However, the overall cost benefit of AA screening remains a debated topic. It will be important to develop risk assessment tools for pre-selecting individuals in whom computed tomography (CT) screening for AA will be cost-effective. Previously, ultrasound has been the standard imaging modality for assessing aortic morphology but with limited range of view. Newer aortic studies using CT angiography, including ours, underline that CT imaging is a viable method for screening of thoracic and abdominal aorta with relatively low radiation dose. Our results showed distinct differences in cardiovascular profile in thoracic AA (TAA) and AAA identified in our general population cohort. This might imply that screening for TAA and AAA disease can be more patient targeted and individualized based on the specific presence of cardiovascular risk factors, in which hypertensive patients were more likely to have TAAs, whereas smoking and hyperlipidaemic patients were more likely to have AAAs.3
