Smoking, lung function and the prognosis of abdominal aortic aneurysm

Greenhalgh, RM Powell, JT Fowkes, FGR Forbes, JF Ruckley, CV Poole-Wilson, PA Browse, N Bulpitt, CJ Burnand, K Coles, EC Fletcher, A Blair, S Clark, R Devine, C Ferguson, K Hearn, S Kerracher, E Logan, S McCabe, A Meer-Baloch, R Mossa, M Rattray, A Wilson, K Brown, L Franks, P Keen, N Rose, C Hassaine, RM Horrocks, M Budd, J Horrocks, M Baird, RN Lamont, P Wilkins, DC Ashley, S Flowerdew, K Baker, A Earnshaw, J Heather, B Gibbons, C Blackett, RL Parvin, SD Harvey, DR Hedges, R Finch, D Hocken, DB Morris, GE Shearman, CP Lear, P Lewis, P Clarke, RJ Ruckley, CV Jenkins, AM Ruckley, CV Cooper, GG Engeset, J Naylor, R Stewart, G Cumming, J McCormick, J Howd, A Turner, A Harper, DR Smith, RC Chamberlain, J Jones, AG Wyatt, MG McKay, AJ Forrester, JC McCollum, P Stonebridge, PA Davidson, AIG Baker, R Forsythe, JLR Lambert, D Duncan, JL Bell, PRF Ratliff, D Callum, KG Nash, JR McPherson, DS Jenner, RE Stewart, R Armitstead, PR Barrie, WW Hamer, DB Powis, S Coen, LD Michaels, J Welsh, CL Hopkinson, BR Wenham, PW Beard, J Auckland, A Black, J Downing, R Hickey, NC Greenhalgh, RM Davies, AH Greenhalgh, RM Nott, D May, ARL McFarland, R Taylor, P Bradley, JWP Paes, T Cameron, AEP McIrvine, A Negus, D Taylor, PR Butler, CM Hoile, RW Pardy, B Ackroyd, J Hamilton, G Lane, R Giddings, AEB Dormandy, J Taylor, R Thomas, M Burnand, KJ Adiseshiah, M Pattison, P Clarke, J Colin, J Rutter, P Brearley, S Pietroni, M McCollum, CN Greaney, MG Reilly, D Paley, WG Lambert, M Hughes, R Blair, S Shand, JEG Donaldson, LA Galloway, JMD Wilkinson, AR Gough, M Mosley, J Matheson, DM Walker, M Hulton, N Aldoori, MI Yeung, CK Hearn, AR Kelly, J Durrans, D Gwynn, B Hopkinson, GB Duffield, RGM Schraibman, IG Hall, R Leveson, SH Clark, J Klimach, O
Rm. Greenhalgh et al., Smoking, lung function and the prognosis of abdominal aortic aneurysm, EUR J VAS E, 19(6), 2000, pp. 636-642
Citations number
Categorie Soggetti
Journal title
ISSN journal
1078-5884 → ACNP
Year of publication
636 - 642
SICI code
Background: the UK Small Aneurysm Trial was established to test the benefit of prophylactic elective surgery for small abdominal aortic aneurysms (4.0 -5.5 cm in diameter) and identify prognostic risk factors, including smokin g. Patients, methods and outcomes: one thousand and ninety patients (902 men a nd 188 women, mean age 69.3 years) were randomised to either early elective surgery or ultrasonography surveillance until the aneurysm diameter exceed ed 5.5 cm, mean follow-up was 4.6 years. Baseline assessments included lung function tests and continue (a smoking marker). The principal outcome meas ures were all-cause mortality and aneurysm rupture. Results: during the course of the trial, aneurysm rupture was diagnosed in 25 patients and 309 patients died. Whereas self-reported smoking status was not significantly associated with survival, patients without any trace of plasma cotinine had a significantly improved long-term (6-year) survival, p = 0.02. Current smokers had a lower FEV1 than post- and never-smokers. FEV 1 was the most powerful predictor of long-term (6-year) survival, the crude death rates per 100 person-years were 9.1, 6.9 and 4.6 for those with FEV1 <1.91, 1.9-2.51 and >2.51 respectively, p = 0.001. Moreover, the rupture r ate was 1.9% per year for patients positive for plasma cotinine compared wi th 0.5% in those without trace of plasma cotinine, p = 0.004. Conclusions: self-reported smoking status underestimates the effect of cont inued smoking on the prognosis of patients with small abdominal aortic aneu rysm. Patients with high plasma cotinine concentrations (smokers) have an i ncreased risk of aneurysm rupture and poorer long-term survival.