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Validation Cohort and Final Results

Frank A. Lederle, MD; Gary R. Johnson, MS; Samuel E. Wilson, MD; Edmund P. Chute, MD; Robert J. Hye, MD; Michel S. Makaroun, MD; Gary W. Barone, MD; Dennis Bandyk, MD; Gregory L. Moneta, MD; Raymond G. Makhoul, MD; and the Aneurysm Detection and Management Veterans Affairs Cooperative Study

Arch Intern Med. 2000;160:1425-1430.

Background  We previously reported the prevalence and associations of abdominal aortic aneurysm (AAA) in 73,451 veterans aged 50 to 79 years who underwent ultrasound screening.

Objective  To understand the prevalence of and principal positive and negative risk factors for AAA, and to assess reproducibility of our previous findings.

Methods  In the new cohort of veterans undergoing screening, 52,745 subjects aged 50 to 79 without history of AAA underwent successful ultrasound screening for AAA, after completing a questionnaire on demographics and potential risk factors.

Results  We detected AAA of 4.0 cm or larger in 613 participants (1.2%; compared with 1.4% in the earlier cohort). The direction and magnitude of the important associations reported in the first cohort were confirmed. Respective odds ratios for the major associations with AAA for the second and for the combined cohorts were as follows: 1.81 and 1.71 for age (per 7 years), 0.12 and 0.18 for female sex, 0.59 and 0.53 for black race, 1.94 and 1.94 for family history of AAA, 4.45 and 5.07 for smoking, 0.50 and 0.52 for diabetes, and 1.60 and 1.66 for atherosclerotic diseases. The excess prevalence associated with smoking accounted for 75% of all AAAs of 4.0 cm or larger in the total population of 126,196. Associations for AAA of 3.0 to 3.9 cm were similar but tended to be somewhat weaker.

Conclusions  Our findings confirm our previous cohort findings. Age, smoking, family history of AAA, and atherosclerotic diseases remained the principal positive associations with AAA, and female sex, diabetes, and black race remained the principal negative associations.

From the Departments of Medicine (Dr Lederle) and Surgery (Dr Chute), Veterans Affairs Medical Center, Minneapolis, Minn; Veterans Affairs Cooperative Studies Program Coordinating Center, West Haven, Conn (Mr Johnson); and the Departments of Surgery, University of California–Irvine, Orange (Dr Wilson), and Veterans Affairs Medical Centers, San Diego, Calif (Dr Hye), Pittsburgh, Pa (Dr Makaroun), Little Rock, Ark (Dr Barone), Tampa, Fla (Dr Bandyk), Portland, Ore (Dr Moneta), and Richmond, Va (Dr Makhoul).

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