Assesment of Risk

Important risk factors for AAA include older age, male sex, smoking, and having a first-degree relative with an AAA. Other risk factors include a history of other vascular aneurysms, coronary artery disease, cerebrovascular disease, atherosclerosis, hypercholesterolemia, and hypertension. Factors associated with a reduced risk include African American race, Hispanic ethnicity, Asian ethnicity, and diabetes. Risk factors for AAA rupture include older age, female sex, smoking, and elevated blood pressure. Clinicians should consider the presence of comorbid conditions and not offering screening if patients are unable to undergo surgical intervention or have a reduced life expectancy.

Smoking Status: Epidemiologic literature commonly defines an “ever smoker” as someone who has smoked 100 or more cigarettes. Indirect evidence shows that smoking is the strongest predictor of AAA prevalence, growth, and rupture rates. There is a dose-response relationship, as greater smoking exposure is associated with an increased risk for AAA.

Family History: Family history of AAA in a first-degree relative doubles the risk of developing AAA. The risk of developing an AAA is stronger with a female first-degree relative (odds ratio [OR], 4.32) than with a male first-degree relative (OR, 1.61). However, evidence is lacking on whether persons with family history experience a different natural history or surgical outcomes than those without such a history.