A population-based case-control study of the familial risk of abdominal aortic aneurysm.

Department of Molecular Medicine and Surgery, Stockholm, Sweden.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter (Impact Factor: 3.52). 12/2008; 49(1):47-50; discussion 51. DOI:10.1016/j.jvs.2008.08.012
Source: PubMed

ABSTRACT Several studies have reported a familial clustering of abdominal aortic aneurysm (AAA) supporting that AAA is an inheritable disease, but few population-based studies can be found. Possible gender differences regarding hereditary patterns have been reported.
The aim of this study was to investigate the risk of developing an AAA for first-degree relatives of patients with AAA in Sweden and compare them with matched controls and their relatives.
All persons (3183) born after 1932, diagnosed with AAA between 2001 and 2005, and a random selection of 15,943 age-, gender-, and region-matched controls were included. First-degree relatives of cases and controls were identified via the Multigeneration Register. Family history of AAA for cases and controls was assessed by linking the relatives to the Hospital Discharge Register and Cause of Death Register. The data were analyzed by conditional logistic regression.
The overall relative risk of AAA associated with family history compared to no family history was 1.9 (95% confidence interval [CI] 1.6-2.2). Comorbidities were more common among the cases than the controls (P < .0001) but the relative risks remained unchanged after adjustment for comorbidities. Stratification for absence or presence of comorbidities showed no significant difference between the two groups (P = .29). The relative risk of AAA for first-degree relatives was similar for women and men (P = .22 for gender differences), ie, the relative risk of AAA was not dependent on the gender of the index person.
In this nationwide survey, the relative risk of developing AAA for first-degree relatives to persons diagnosed with AAA was approximately doubled compared to persons with no family history. Neither the gender of the index person nor the first-degree relative influenced the risk of AAA.

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    ABSTRACT: Studies of family history (FH) have long been used to estimate the heritability of cardiovascular diseases (CVDs). Genome-wide association studies (GWAS) of several CVDs, such as coronary heart disease (CHD), stroke, aortic aneurysm (AA), atrial fibrillation (AF), and venous thromboembolism (VTE), have found several novel gene loci and have revealed new biological mechanisms. However, most of the heritability for common CVDs remains to be discovered. Studies of FH will continue to be the easiest way to measure the inherited and non-genetic component of a CVD, as FH represents the sum of interactions between environmental and genetic factors. Many past FH studies of CVDs were hampered by recall and selection bias, small study sizes, retrospective case-control study designs, and a lack of follow-up data. Large nationwide register-based follow-up studies of FH have become possible in countries such as Sweden, Denmark, and Iceland. For instance, nationwide family studies of CVDs such as CHD, stroke, AA, AF, and VTE have been published. Such nationwide family studies may be very helpful for the planning of genetic studies to identify the missing heritability of CVDs. Moreover, reliable estimates of the familial risks of CVDs may be helpful for clinical risk assessment. In this article, the design, methodology, results, clinical and genetic implications, and pros and cons of nationwide FH studies are reviewed. The focus is on studies based on Swedish healthcare data. New findings from these studies will be summarised, and future opportunities will be presented.
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    ABSTRACT: The risk factor profile is similar between patients with abdominal aortic aneurysm (AAA) and coronary heart disease (CHD). CHD is more common in the north of Sweden. It is unknown whether similar regional differences in the incidence of AAA exist. The aims of this study were to investigate whether there is a regional gradient of AAA incidence, and to compare time trends and the frequency of interventions between regions. Swedish citizens have a 12-digit personal identification number. The Swedish Hospital Discharge Register covers inpatient care (diagnosis, admission, procedure codes, sex, date of birth, county). Population size was obtained from the central statistical bureau. Regions were south, mid and north. All records for 1990-2005 were extracted and 35 418 individuals with AAA were identified (74.8 per cent men). The highest age-standardized incidence (102.7 per 100,000) was found in men in the north region. The age-adjusted incidence ratio for men in the north region compared with the south was 1.38 (95 per cent confidence interval 1.34 to 1.42). Similar differences were found in women: incidence ratio for north compared with south region 1.39 (1.07 to 1.81). The proportion treated was larger in men and varied by region: 46.9 per cent of men in the mid region compared with 43.7 per cent in the south received treatment (P < 0.001), whereas 29.8 per cent of women in the north region versus 25.4 per cent in the south had an intervention (P = 0.001). The incidence did not increase over time. The higher incidence of AAA in the north of Sweden corresponds well with reported CHD patterns. The incidence of AAA in the population did not increase significantly over time, in contrast to the increasing intervention rates.
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    ABSTRACT: While a positive family history (FH) is a known risk factor for developing an aneurysm, its association with the extent of disease has not been established. We evaluated the influence of a FH of aortic disease with respect to the pattern and distribution of aortic aneurysms in a given patient. From November 1999 to November 2011, 1263 patients were enrolled in physician-sponsored endovascular device trials to treat aortic aneurysms. Of the 555 patients who were alive and returning for follow-up, we obtained 426 (77%) family histories. Three-dimensional imaging studies were used to identify the presence of aneurysms; 36% (155/426) of patients had a FH of aortic aneurysms and 5% (21/155) had isolated intracranial aneurysms. A logistic regression model was used to compare aortic morphology between patients with a positive or negative FH for aneurysms. Patients with a positive FH of aortic aneurysms were younger at their initial aneurysm (63 vs 70 years; P < .0001), more frequently had proximal aortic involvement (root: odds ratio [OR], 5.4; P < .0001; ascending: OR, 2.9; P < .001; thoracic: OR, 2.2; P = .01) with over 50% of FH patients ultimately developing suprarenal aortic involvement (P = .0001) and had a greater incidence of bilateral iliac artery aneurysm (OR, 1.8; P = .03). FH is an important tool that provides insight into the expected behavior of the untreated aorta and has significant implications for the development of treatment strategies. These findings should be used to guide patient's management with regard to treatment, follow-up paradigms, genetic testing, and screening of other family members.
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