Anneli Linné

High prevalence of abdominal aortic aneurysms in brothers and sisters of patients despite a low prevalence in the population

OBJECTIVE Population-based screening for abdominal aortic aneurysms (AAAs) in elderly men is organized in many regions and countries in the Western world, and the prevalence of disease is reported to decline. Whether the prevalence among those with a family history also is declining is unknown. The primary purpose of this study was to assess the prevalence of AAAs among siblings of persons with AAAs and to investigate the proportion of siblings already diagnosed by opportunistic screening. METHODS Patients treated for AAAs from January 2008 through December 2010 (n = 412) in Stockholm, Sweden, were screened for siblings. Seven hundred seventy-nine siblings were identified. All siblings <80 years residing in Stockholm County were considered eligible and were invited to participate in the study (n = 174). Deceased siblings were not included in the study, regardless of the cause of death. One hundred fifty siblings were enrolled in the study after informed consent was provided. One hundred thirty-four siblings were screened for AAAs with ultrasound scan and maximum aortic, infrarenal, anteroposterior, external (outer-to-outer) aortic diameter was measured. Characteristics of siblings with and without AAAs were compared. RESULTS The mean age of the screened siblings was 66.4 years (standard deviation, 7.1). Of the siblings, 11% were found to have an AAA, 17% (n = 11) of the brothers, and 6% (n = 5) of the sisters. Only 11% of the siblings were screened for AAAs before the study. One of 16 siblings with AAAs was <65 years. Ever smoking was evident in 81% of the AAA siblings compared to 59% in the non-AAA siblings. Factors associated with increased risk of AAAs in the multivariate regression analysis were: male sex (odds ratio, 3.4; 95% confidence interval, 1.1-10.8; P = .04) and age >65 (odds ratio, 10.8; 95% confidence interval, 1.3-86.4; P = .03). Ever smoking was not statistically significant as a risk. CONCLUSIONS A strikingly high prevalence of AAAs in siblings was found as compared to the reported declining aneurysm prevalence in elderly men in the Western world. Systematic improvements regarding screening of first-degree relatives is mandated and selective screening of siblings is an underused tool to prevent death from aneurysm disease, both among men and women.

Reasons for non-participation in population-based abdominal aortic aneurysm screening.

A population‐based screening programme for abdominal aortic aneurysm (AAA) started in 2010 in Stockholm County, Sweden. This present study used individual data from Swedens extensive healthcare registries to identify the reasons for non‐participation in the AAA screening programme.

Flywheel resistance exercise to maintain muscle oxidative potential during unloading.

BACKGROUND As spaceflight compromises skeletal muscle oxidative and aerobic work capacity, this study assessed the efficacy of resistance exercise (RE) to counteract muscle metabolic perturbations induced by 5 wk unilateral lower limb unloading (UL). METHODS There were 21 men and women (30-56 yr) who were randomly assigned to either UL with (Group, Grp; UL+RE; N = 10) or without (Grp UL; N = 11) concurrent RE. Iso-inertial RE comprised four sets of seven maximal coupled concentric-eccentric knee extensions executed 2-3 times per week. Percutaneous biopsies were obtained from m. vastus lateralis before and after either intervention. Levels of mRNA expression of factors regulating skeletal muscle oxidative capacity i.e., peroxisome proliferator-activated receptor gamma coactivator-1 (PGC-1alpha) and vascular endothelial growth factor (VEGF), and glycolytic capacity, i.e., phosphofructokinase (PFK), glycogen phosphorylase and synthase, hexokinase, and phosphorylase kinase alpha1, were subsequently analyzed. RESULTS Grp UL showed decreased (36%) PGC-1alpha expression, increased (1.5-fold) PFK expression, and a trend toward decreased VEGF post-intervention. Grp UL+RE showed no changes. DISCUSSION These results suggest that 5 wk unloading reduces skeletal muscle oxidative capacity and increases glycolytic enzyme activity. More importantly, only 12 bouts of high-force, low-volume resistance exercise attenuated these responses. Thus, the current resistance exercise paradigm emphasizing eccentric overload effectively counteracts unwarranted metabolic alterations induced by 5 wk unloading and may, therefore, aid in maintaining skeletal muscle integrity and endurance, and hence astronaut health and fitness during spaceflight.

Low Post-operative Mortality after Surgery on Patients with Screening-detected Abdominal Aortic Aneurysms: A Swedvasc Registry Study

OBJECTIVES Screening for abdominal aortic aneurysms (AAAs) substantially reduces aneurysm-related mortality in men and is increasing worldwide. This cohort study compares post-operative mortality and complications in men with screening-detected vs. non-screening-detected AAAs. METHODS Data were extracted from the Swedish National Registry for Vascular Surgery (Swedvasc) for all screening-detected men treated for AAA (n = 350) and age-matched controls treated for non-screening-detected AAA (n = 350). RESULTS There were no differences in baseline characteristics besides age, which was lower in the screening-detected group than in the non-screening-detected group (median 66 vs. 68, p < .001). Open repair was used more frequently than endovascular aortic repair (EVAR) in patients with screening-detected AAAs than in non-screening-detected controls (56% vs. 45% p = .005). No differences in major post-operative complications at 30 days were observed between the groups. In patients treated with open repair there were no differences in 30-day, 90-day or 1-year mortality in screening-detected patients compared to non-screening-detected controls (1.0% vs. 3.2% p = .25, 2.1% vs. 4.5% p = .23, 4.1% vs. 5.8% p = .61). None of the patients treated with EVAR in either group died within 30 days. The 90-day mortality after EVAR was lower in patients with screening-detected AAA than in those with non-screening-detected AAAs (0.0% vs. 3.1%, p = .04). No difference in the 1-year mortality was detected in the EVAR-patients between the two groups (1.4% vs. 4.7%, p = .12). CONCLUSIONS The contemporary post-operative mortality after AAA surgery was low in this national audit of patients with screening-detected AAAs and age-matched controls. Patients with screening-detected AAAs have the same frequency of complications at 30 days as patients with non-screening-detected AAA. This study gives further support to national screening programs for the detection of AAA in men.

Screening of siblings to patients with abdominal aortic aneurysms in Sweden

Abstract Objective. The prevalence of Abdominal Aortic Aneurysm (AAA) is higher for First Degree Relatives to AAA-patients compared to the general population, regardless of sex. The prevalence of AAA is also higher in the North of Sweden compared to the Mid and South. A regional strong hereditary trait has been suggested as an explanation to this. The aim of this study was to investigate if siblings to AAA-patients in the North have a higher prevalence of AAA compared to siblings in the Mid-region. Design. Cohort study. Materials and Methods. All patients treated for AAA in a northern region (Norrbotten county, North) were screened for siblings. Consenting siblings, age 40–80, were examined (n = 379) with ultrasound. The results were compared to the previously published results of 150 ultrasound-screened siblings in the Mid-region (Stockholm county). Results. The male/female ratio in the sibling cohort was 48% vs 52%. The prevalence of AAA in siblings in the North was 37/379 (brothers 14%, sisters 6%). This was not different from the prevalence among the Mid-region siblings 16/150 (brothers 17%, sisters 6% (p = 0.75). The distribution of risk factors was similar in the two regions. Conclusion. The results reinforce the importance of a more systematic approach towards selective screening of all siblings to AAA patients. Ultrasound should be performed in all eligible siblings, since the distribution of AAA is similar over regions. A correlation between the familial distribution and the reported high prevalence of AAA in general population in the North could not be shown.

Abdominal aortic aneurysm screening attendance: Effect of removing the examination fee

Objectives The organized population-based screening programme for abdominal aortic aneurysm in Stockholm, Sweden, started in 2010. An examination fee was initially charged, but later removed because of a policy change. We examined the effect on screening attendance of removing the fee. Methods The periods before and after removing the examination fee were compared with regard to screening attendance, overall, by municipality and by district. Results Screening attendance was 79.2% in the period with an examination fee and 79.9% in the period without an examination fee (p = 0.1787), with no significant change in screening attendance between the periods. Conclusions Although removing examination fees has been shown to have a positive impact on attendance in other screening programmes, we did not find this association in our study.