Assessing Cardiovascular Risk and Medication Management in Patients with Abdominal Aortic Aneurysm across Three Decades.

Abstract

Objective: Patients with abdominal aortic aneurysm (AAA) have higher mortality due to increased cardiovascular risk. This retrospective study provides an overview of cardiovascular comorbidities and medication prescriptions in patients with AAA over different time periods.

Methods: This single centre, retrospective cohort study included all patients with AAA at Amsterdam University Medical Centers from January 1989 to July 2023. Trends in cardiovascular comorbidities and medication prescriptions at AAA diagnosis were assessed across six periods: 1989 - 1998, 1999 - 2003, 2004 - 2008, 2009 - 2013, 2014 - 2018, and 2019 - 2023. Two year survival rates were analysed, and a multivariable Cox proportional hazards model was used to examine the association between cardiovascular comorbidities and medication prescriptions with all cause death.

Results: The study included 7 957 patients (78.8% male; mean age 71.8 ± 9.9 years). Common cardiovascular comorbidities at AAA diagnosis were hypertension (39.7%), transient ischaemic attack (27.1%), and myocardial infarction (17.5%). Frequently prescribed medications included platelet inhibitors (40.5%), beta blockers (28.9%), and statins (27.4%). Over time, cardiovascular comorbidities, medication prescriptions, and age at diagnosis increased. The two year survival rate was 77.7% (95% confidence interval 76.6 - 78.7%), with a significant increase in all cause death over time (log rank p < .001). Advanced age (p < .001; hazard ratio [HR] 1.065), chronic renal failure (p < .001; HR 1.545), heart failure (p = .002; HR 1.198), and chronic obstructive pulmonary disease (p < .001; HR 1.354) were associated with increased mortality risk, whereas dyslipidaemia (p < .001; HR 0.818) was associated with a decreased risk. Insulin (p < .001; HR 1.373) and diuretic use (p < .001; HR 1.223) were associated with increased mortality risk, whereas platelet inhibitors (p = .006; HR 0.899) and nitrates (p = .031; HR 0.858) were linked to a decreased risk.

Conclusion: Cardiovascular comorbidities and medication prescriptions have increased over time in patients with AAA. Low prescription rates of cardiovascular medication at diagnosis suggest inadequate risk management, emphasising the need for stricter cardiovascular risk management to reduce mortality.