CHICAGO — One of every nine men over age 59 years with a diagnosis of stroke or transient ischemic attack had an abdominal aortic aneurysm in a prospective study of 499 patients.
Among all patients admitted for stroke or TIA, the prevalence of abdominal aortic aneurysm (AAA) on ultrasound was 5.8%. This is comparable to that in other populations and was not significant.
AAA prevalence was 11.1% in a subgroup of 235 men aged 59 years and older (median 72 years), Dr. Niels H.A. Van Lindert and colleagues reported at the annual meeting of the Radiological Society of North America. The prevalence in the subgroup was significantly higher than the 4.0%-8.1% prevalence found in three recent population-based screening studies in men over 59 years of age.
The finding could lead to improved screening and earlier treatment of this high-risk group, said Dr. Van Lindert, of the Gelre Hospitals Apeldoorn (the Netherlands). Although the use of ultrasound is noninvasive, low-cost, accurate, and fast, most abdominal aneurysms are found by chance in men of older age and with a history of smoking.
“In our group, 55% of aneurysms were in nonsmokers, which meant that detection would not have occurred following task force rules,” he said.
The United States Preventive Services Task Force (USPSTF) recommends a one-time ultrasonography screening of all men aged 65-75 years with a history of smoking. The USPSTF makes no recommendation for or against screening for AAA in men aged 65-75 years who have never smoked, and recommends against routine screening for AAA in women.
Dr. Van Lindert recommended that all men older than 59 years of age admitted with a stroke or TIA should be screened for an AAA. Further studies are needed to determine the cost-benefit aspects of screening in this patient population with a shorter life expectancy, he said.
Abdominal aortic diameter was measured by ultrasonography in 518 patients (median age 71 years, 61% men) visiting their neurology department with a primary diagnosis of stroke or TIA between January 2002 and January 2005. In all, 373 had had an ischemic stroke, 125 a TIA, and 20 a cerebral hemorrhage.
An aneurysm was defined as an abdominal aorta with a diameter of at least 3.0 cm. Maximum diameter was 3.0-3.9 cm in 18 patients, 4.0-4.9 cm in 6 patients, and 5.0 cm or more in 5 patients.
The investigators found no association between AAA prevalence and cerebrovascular accident subtype or smoking, both of which have been previously identified as risk factors for AAA.
The investigators reported no conflicts of interest.