Long-term incidence of myocardial infarct, stroke, and mortality in patients operated on for abdominal aortic aneurysms. Cognitive-behavioral treatment of women's body-image dissatisfaction. Selective screening for abdominal aortic aneurysm. Endovascular treatment of ruptured abdominal aortic aneurysm: is there a long-term benefit at follow-up? Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. The fate of patients undergoing surveillance of small abdominal aortic aneurysms. Early and late outcome of surgical repair for small abdominal aortic aneurysms: a population-based analysis. Impaired results of a randomised double blinded clinical trial of propranolol versus placebo on the expansion rate of small abdominal aortic aneurysms. Cardiovascular risk profile and outcome of patients with abdominal aortic aneurysm in out-patients with atherothrombosis: data from the Reduction of Atherothrombosis for Continued Health (REACH) Registry. Abdominal Aortic Aneurysm (Aaa): Cost-Effectiveness of Screening, Surveillance of Intermediate-Sized Aaa, and Management of Symptomatic Aaa An analysis of drug modulation of abdominal aortic aneurysm growth through 25 years of surveillance. High-risk and low-risk screening for abdominal aortic aneurysm both reduce aneurysm-related mortality. A stratified analysis from a single-centre randomised screening trial. The Outcome of Endovascular Repair of Small Abdominal Aortic Aneurysms A multicenter controlled clinical trial of open versus endovascular treatment of abdominal aortic aneurysm. Reduction in the incidence of acute kidney injury after aortic arch surgery with low-dose atrial natriuretic peptide: A randomised controlled trial Statin therapy is associated with improved survival after endovascular and open aneurysm repair. Efficacy and safety of prescription omega-3-acid ethyl esters for the prevention of recurrent symptomatic atrial fibrillation: a prospective study.
OBJECTIVE The risks of myocardial infa rct ion ( MI ) and stroke after abdominal aortic aneurysm ( AAA ) resection are not known . Prophylaxis with aspirin and statins is not generally recommended , although patients with AAAs have an increased prevalence of cardiovascular atherosclerosis . We report the incidences of MI , stroke , and death in an unselected national cohort of patients operated on for AAAs , with the general population as the control group . METHODS In a matched cohort study , 11,094 Danish patients who underwent acute or elective open AAA repair from January 1986 through June 2009 were compared with four r and omly chosen age- and sex-matched individuals ( controls ) from the general population ( n = 44,364 ) . Data were collected retrospectively from the Danish Vascular Registry ( Karbase ) , the National Population Registry , and the National Inpatient Registry . The groups were analyzed for the incidences of MI , stroke , and death , with up to 20 years of follow-up . RESULTS AAA patients had an annual MI incidence of 2.5 % ( hazard ratio , 2.1 ; 95 % confidence interval [ CI ] , 1.9 - 2.2 ) compared with the general population . The annual incidence of stroke was 2.9 % ( hazard ratio , 1.8 ; 95 % CI , 1.6 - 1.9 ) , and there was a 2.4-fold ( 95 % CI , 2.3 - 2.4 ) increase in the hazard of all-cause mortality compared with the general population . CONCLUSION AAA patients of both sexes have a high risk of atherosclerotic events ( MI , stroke ) and death , so lifelong prophylaxis must be considered from our epidemiologic data . R and omized trials investigating the potential benefit of aspirin and statin therapy in AAA patients are needed Body-image dissatisfaction is a problem that affects a substantial minority ofwomen and cuts across various diagnostic groups . College women with a significant level ofbody-image dissatisfaction were r and omly assigned to either a cognitive-behavioral treatment ( CBT ) program  ( n = 15 ) or to a waiting-list control group  ( n = 16 ) . The CBT program consisted of six structured , individual sessions that applied cognitive-behavioral procedures to the problem of negative body image . At pretest , posttest , and 7-week foUow-up , multiple aspects of body image and other areas of psychosocial functioning were assessed . Relative to the control condition , the CBT program successfully improved affective body image , weakened maladaptive body-image cognitions , and enhanced social self-esteem and feelings about physical fitness and sexuality . Treatment effects were largely maintained at followup . After posttest , the control group received a 3-week treatment with immediate effects that generally replicated those obtained in the 6-wer program Abdominal aortic aneurysm ( AAA ) meets the criteria as a possible target for early detection by screening or case-finding , although the effectiveness of such an intervention has not yet been demonstrated . The purpose of this study was to estimate the increase in cost-effectiveness that would result from selectively screening individuals based on their risk of AAA . Data from a hospital-based case-control study involving 78 men with AAA ( unruptured ) and 99 male controls were used to derive a risk function based on age , cigarette smoking , high blood pressure , history of heart disease , body mass index and serum high-density lipoprotein , using logistic regression analysis . For each of the control subjects ( assumed to be a representative sample of the general population of elderly men ) , the risk of AAA was estimated and multiplied by the expectation of life to give a measure of the potential benefit of screening . The proportion of the total potential benefit that would be obtained by screening only those with a given level of risk was estimated , and this was related to the proportion of the population screened . In order to obtain 80 % of the total potential benefit among men , we found that it would be necessary to examine 52 % of the elderly male population if using a risk function based on age alone ; 35 % would have to be screened if age and smoking were included ; and 17 % would require screening if all the risk factors were included . Selective screening for AAA appears to be a promising strategy , but a prospect i ve study is required to demonstrate that the predictions are valid AIM Several studies have shown the feasibility of endovascular repair of ruptured abdominal aortic aneurysms ( rEVAR ) . However , the role and value of rEVAR remains controversial due to selection bias and lack of long-term results . In the present study we describe our short- and long-term results of treating patients with rEVAR irrespective of hemodynamic condition and challenging anatomy . METHODS In April 2006 we started the single centre prospect i ve non-r and omised Ruptured Aneurysm Study ( RASA ) . During a four year enrolment period all consecutive patients presenting with infrarenal ruptured AAA ( rAAA , N.=117 ) were assessed for preferential rEVAR treatment . A rAAA was defined as extravasation of blood or hematoma outside the AAA due to transmural tear in the infrarenal abdominal aorta wall documented by preoperative computed tomography ( CT ) angiography examination or during open repair . Patients with challenging anatomy ( infrarenal neck length below 15 mm and neck angulation above 60 degrees ) were included as part of a damage control concept . Complication and mortality rates were studied at 30 days and yearly afterwards . RESULTS Thirty-five patients ( 33 % of all admitted rAAA ) were treated with rEVAR and 42 % of them were considered hemodynamically unstable ( systolic blood pressure < 100 mmHg ) and 30 % had challenging AAA anatomy . The mortality rate at 30 days in the rEVAR group was 17 % , in the open repair group 31 % , and in the entire rAAA group ( including abstained patients ) 36 % . During the first 30 days , 18 rEVAR patients experienced complications with nine re- interventions as a result . Long-term mortality of the rEVAR patients was 34 % after a median follow-up of 3.4 years . All deaths after one year follow-up were non-AAA related . Multivariate analysis shows that Hardman index , presence of peripheral arterial obstructive disease and lowest systolic blood pressure during surgery are independently associated with long-term survival . Challenging rAAA anatomy was not associated with impaired survival . CONCLUSION Our study shows that rEVAR is feasible irrespective of hemodynamic condition and that it is associated with relative low mortality rates . Challenging rAAA anatomy may not affect overall long-term survival , but six out of ten patients remain unsuitable for rEVAR because of inappropriate anatomy CONTEXT Limited data are available to assess whether endovascular repair of abdominal aortic aneurysm ( AAA ) improves short-term outcomes compared with traditional open repair . OBJECTIVE To compare postoperative outcomes up to 2 years after endovascular or open repair of AAA in a planned interim report of a 9-year trial . DESIGN , SETTING , AND PATIENTS A r and omized , multicenter clinical trial of 881 veterans ( aged > or = 49 years ) from 42 Veterans Affairs Medical Centers with eligible AAA who were c and i date s for both elective endovascular repair and open repair of AAA . The trial is ongoing and this report describes the period between October 15 , 2002 , and October 15 , 2008 . INTERVENTION Elective endovascular ( n = 444 ) or open ( n = 437 ) repair of AAA . MAIN OUTCOME MEASURES Procedure failure , secondary therapeutic procedures , length of stay , quality of life , erectile dysfunction , major morbidity , and mortality . RESULTS Mean follow-up was 1.8 years . Perioperative mortality ( 30 days or inpatient ) was lower for endovascular repair ( 0.5 % vs 3.0 % ; P = .004 ) , but there was no significant difference in mortality at 2 years ( 7.0 % vs 9.8 % , P = .13 ) . Patients in the endovascular repair group had reduced median procedure time ( 2.9 vs 3.7 hours ) , blood loss ( 200 vs 1000 mL ) , transfusion requirement ( 0 vs 1.0 units ) , duration of mechanical ventilation ( 3.6 vs 5.0 hours ) , hospital stay ( 3 vs 7 days ) , and intensive care unit stay ( 1 vs 4 days ) , but required substantial exposure to fluoroscopy and contrast . There were no differences between the 2 groups in major morbidity , procedure failure , secondary therapeutic procedures , aneurysm-related hospitalizations , health-related quality of life , or erectile function . CONCLUSIONS In this report of short-term outcomes after elective AAA repair , perioperative mortality was low for both procedures and lower for endovascular than open repair . The early advantage of endovascular repair was not offset by increased morbidity or mortality in the first 2 years after repair . Longer-term outcome data are needed to fully assess the relative merits of the 2 procedures . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00094575 OBJECTIVES Increasing numbers of patients with small abdominal aortic aneurysms ( AAA ) are being diagnosed . The aim of this paper is to define the fate of those patients undergoing surveillance of small AAAs .  SETTING U.K. district general hospital . METHODS A prospect i ve study has been carried out of all patients undergoing surveillance .  At the time of the first consultation the patient was assessed , a Detsky score calculated and the referral source noted . End points of the study were elective repair of the aneurysm , aneurysm rupture or death of the patient . RESULTS Details of 267 patients were analysed . The referral source was general practitioner in 39 % , patients with peripheral vascular disease in 32 % and department of urology in 21 % . None were referred from population screening . The cumulative 5-year risks of rupture , elective repair or non-AAA related deaths were 15 % , 26 % and 46 % for all patients , 4 % , 13 % and 38 % for patients initially presenting with AAA less than 4 cm diameter and 21 % , 42 % and 54 % for patients presenting with an AAA 4 - 5.5 cm diameter . All but one of 11 patients whose aneurysm ruptured were unfit or had declined elective repair . There were 56 non-AAA related deaths , the majority due to cardiovascular causes . Those patients with low Detsky scores had a 5-year survival of 62 % , those with high scores 44 % . The age/sex matched survival or a normal population at 5 years in 80 % . CONCLUSION Overall the non-AAA related mortality was greater than the risks of rupture or elective repair . It is important to bear in mind the poor prognosis of this group of patients compared with a normal population when considering elective repair of small AAAs PURPOSE Whether small abdominal aortic aneurysms ( AAAs ) ( < or = 5 cm in diameter ) should be repaired early to enhance late survival remains controversial . Long-term population -based data on the surgical outcome for small AAAs may help to establish practice guidelines until r and omized clinical trials are completed . METHODS To examine an entire community experience with small AAAs , we conducted a population -based analysis of the recognition , reasons for operation , perioperative mortality rates , and late survival  in Olmsted County , Minnesota . RESULTS The incidence of recognized small AAAs increased thirtyfold during a 30-year period . The propensity to repair small AAAs also increased during the same period . Eventually one third of small AAAs were repaired . The primary reasons for surgical consultation and operation were presence of the aneurysm ( 49 % ) , expansion on serial examination ( 28 % ) , nonspecific abdominal or back symptoms ( 18 % ) , and excessive patient anxiety about the aneurysm ( 5 % ) . Community operative mortality rates for small AAAs were low ( 2.6 % ) compared with those for large aneurysms ( 5.5 % ) ( p = 0.65 ) . However , the observed 5-year survival rate for the group undergoing repair of small aneurysms was 62 % , which was significantly less than the 83 % expected survival for the general population ( p < 0.05 ) . Relative survival for the operated small and large aneurysms was similar . The primary cause of death for both groups was myocardial infa rct ion . CONCLUSIONS The results of our population -based analysis indicate that early operative results for elective repair of small AAAs are excellent , but late survival remains significantly impaired by coronary heart disease . Consequently , our data question whether early repair of small AAAs will enhance late survival . Until r and omized clinical trials on management of small AAAs are completed , most small AAAs should be monitored for expansion and operated on electively when they approach or enter the range of 5 to 6 cm in good-risk patients BACKGROUND To study the propranolol treatment of small abdominal aortic aneurysms ( AAA ) concerning intention to treat , side effects , and inhibition of expansion . METHODS DESIGN Two-year lasting prospect i ve r and omised double-blinded intervention trial . SETTING Hospital-based mass screening for AAA with annual ambulatory control of small AAA . PARTICIPANTS Of 122 screening-diagnosed small AAA , 51 ( 42 % ) were excluded because of contraindications or present beta-blockage , and 17 refused participation . Thus , 54 ( 44.3 % ) were included . INTERVENTION Participants were r and omised to 40 mg propranolol twice a day or placebo . MEASURES The same observed was used to follow-up AAA-expansion , side effects , quality of life ( QL ) , branchial and ankle blood pressure ( ABI ) , and pulmonary function ( FEV1 and FVC ) . RESULTS Sixty percent in the propranolol group , and 25 % in the placebo group dropped out , mainly caused by dyspnoea in the propranolol group ( RR=1.74 , 95 % C.I. : 1.06 - 2.86 ) . Five ( 16.7 % ) died in the propranolol group , while 1 ( 4.2 % ) died in the placebo group ( RR=1.6 ( 1.02 - 2.51 ) ) . Furthermore , decreased pulmonary function , ABI , and QL was noticed in the propranolol group . Consequently , the trial was stopped after two years . Ninety-five percent of the measurements of the AAA were measured within 2 mm variation . If expansion was defined as above 2 mm annually , the relative risk of expansion in the placebo group was 1.17 ( 0.74 - 1.85 ) , and 2.44 ( 0.88 - 6.77 ) among the non-drop-outs . CONCLUSIONS Only 22 % of small screenings-diagnosed AAA were treatable with propranolol for two years . Consequently , only large scale studies are capable of showing potential minor inhibition of expansion by propranolol . However , whether such treatment ever becomes ethically acceptable is debatable OBJECTIVE Data sets regarding patients with abdominal aortic aneurysm ( AAA ) have almost universally been restricted to single geographic regions . We aim ed to obtain data on the risk factor profile and cardiovascular ( CV ) co-morbidity among multi-ethnic patients with known AAA in the global REACH ( REduction of Atherothrombosis for Continued Health ) Registry . METHODS The REACH Registry is an international , prospect i ve , observational out-patient registry enrolling out- patients > /=45 years of age with established coronary artery disease ( CAD ) , cerebrovascular disease ( CVD ) or peripheral arterial disease ( PAD ) or with at least three atherothrombotic risk factors . This report includes observations pertaining to 68,236 out- patients enrolled in 44 countries . MAIN OUTCOME MEASURES Gender , ethnic origin , CV risk factors , established atherosclerotic disease ( CAD , CVD and PAD ) at baseline , and CV outcome events at 1-year were compared in patients with and without AAA . RESULTS An AAA was reported in 1722 ( 2.5 % ) of 68,236 out- patients enrolled in the REACH Registry . Older age ( 73 + /- 8 vs 68 + /- 10 , P < .0001 ) , male gender ( 81 % vs 63 % , P < .0001 ) , White ethnicity ( 79 % vs 67 % , P < .0001 ) and a history of smoking ( 81 % vs 55 % , P < .0001 ) were independently related to the diagnosis of AAA . There was a weaker association with hypertension or hypercholesterolemia , and an inverse relation with diabetes . Fatal and non-fatal coronary and cerebrovascular event rates were not different between the AAA and non-AAA cohorts , but individuals with AAA suffered increased rates of other cardiovascular deaths ( 1.39 % vs 0.94 % , P = .0135 ) , hospitalizations for atherothrombotic events ( 14.1 % vs 9.3 % , P < .0001 ) due to increased rates of revascularization procedures , and new or worsening PAD ( 3.7 % vs 1.3 % , P < .0001 ) at 1-year follow-up . CONCLUSION This study , the largest published to date , presents the CV risk profile and outcome of patients with an established diagnosis of AAA from a cohort of patients with either overt manifestations of CV disease or multiple risk factors , and further defines these patients in a multi-ethnic , global context Physicians must make decisions about screening patients for abdominal aortic aneurysms ( AAAs ) , monitoring or referring for surgery patients with AAAs of various sizes , and assessing patients with symptoms that may be related to AAAs . This review article analyzes the evidence for each scenario . The effectiveness and cost-effectiveness of screening for AAA is based on results from four r and omized controlled trials . A cost-effectiveness analysis using a Markov model showed that ultrasound screening of white men beginning at age 65 is both effective and cost-effective in preventing AAA-related death . Such screening would have a small but real impact over a 20-year period in these men . For patients with a known AAA — which is often detected incidentally — the evidence clearly suggests periodic ultrasound surveillance for those with small AAAs ( 3.0–3.9 cm in diameter ) and elective surgical repair for those with large AAAs ( = 5.5 cm ) . Two recent r and omized controlled trials have shown that early surgical repair confers no survival benefit compared with periodic surveillance for patients with intermediate-sized AAAs ( 4.0–5.5 cm in diameter ) , so those patients can also be monitored . Some centers choose to increase the frequency of monitoring to every 3 to 6 months when the AAA reaches 5.0 cm . Factors to consider in assessing symptomatic patients include the high risk of life-threatening conditions , the potential increased risk of death or poor outcome with delay in diagnosis , the limitations of ultrasound in identifying whether symptoms are due to known or suspected AAA , and the timely availability of computed tomography or other imaging tests . If available , computed tomography is preferred in patients with recent or severe symptoms , since it is better at detecting retroperitoneal hemorrhage and other complications and in providing preoperative definition of the anatomy BACKGROUND A modest ( 41 % ) reduction in abdominal aortic aneurysm ( AAA ) growth rate is likely to delay AAA-related events ( surgery or rupture ) by 5 years , making the notion of AAA medical treatment very appealing . R and omized controlled trials of commonly used existing medications are expensive and ethically question able . This study review ed the independent associations of commonly used medications and AAA growth during a 25-year period of AAA surveillance . METHODS The study included all patients monitored through an AAA screening and surveillance program .  Records of AAA size , risk factors , outcomes , death , and medications were entered into a continually up date d data base . AAA growth rates were calculated using a flexible hierarchical model . A multivariate model was used to test for associations independent of confounders . RESULTS The study comprised 1269 patients ( 94.1 % men ) who had a mean age of 67 years . The median starting diameter was 35 mm , the end diameter was 44 mm , and follow-up was 3.4 years . Drugs used in the treatment of diabetes were associated with a 56 % reduction in AAA growth rate ( P = .01 ) independent of confounding factors , including other therapeutic agents ( P = .003 ) . Angiotensin-receptor blockers and potassium-sparing diuretics were also associated with slower AAA growth rates , although these effects were not independent of all confounders . CONCLUSION Diabetes or its medications , or both , have a negative effect on AAA growth . Because of polypharmacy , demonstrating the independent effects of individual drugs affecting the renin-angiotensin system was not possible . In light of this analysis , however , strong associations between angiotensin-receptor blockers and aldosterone-receptor blockers and slowed AAA progression are credible BACKGROUND Cardiovascular diseases and chronic obstructive pulmonary disease ( COPD ) are both associated with abdominal aortic aneurysms ( AAA ) . The aim of this study was therefore to analyse whether screening for AAA could be restricted to men with such diseases ( high risk group ) . METHODS Before the date of r and omisation of a population screening trial of 12,639 64 - 73-year-old males , all discharge diagnoses from the National Patient Registry concerning AAA-related diseases were merged with the screening results on attendance , AAA prevalence , and AAA-related mortality and overall mortality . Differences in proportions were compared by Chi square tests and differences in mortality by Cox regression analyses . RESULTS The attendance rate was 78.8 % and 6.7 % had an AAA in the high risk group compared to 75.8 % attendance ( P<0.001 ) and 2.9 % ( P<0.001 ) in the remaining population . Cumulatively , screening of only high risk men with would have required 72.9 % ( 95 % C.I. : 72.3 - 74.5 % ) fewer screening invitations , would have discovered 46.1 % ( 95 % C.I. : 38.9 - 53.4 % ) of the AAA cases diagnosed and prevented 46.7 % ( 95 % C.I. : 28.3 - 65.7 % ) of the AAA-related deaths . However , screening decreased AAA-related mortality both among men with and without known COPD or cardiovascular diseases : mortality ratio : 0.22 ( 95 % C.I. : 0.08 - 0.65 ) , P=0.006 , and 0.24 ( 95 % C.I : 0.09 - 0.63 , P=0.004 , respectively . CONCLUSION High-risk population screening would prevent less than half of AAA-related deaths . Therefore , restricting screening to such high-risk groups does not seem justified , but cost effectiveness analyses are needed to reach a firm conclusion Objective : To assess the outcome of endovascular repair ( EVAR ) of small abdominal aortic aneurysms ( AAA , ≤5.5 mm maximum diameter ) in Australia . Summary Background Data : R and omized trials have suggested that small AAAs should not be treated by open surgery . EVAR is associated with less perioperative mortality than open surgery for large AAAs . We assessed the outcome of EVAR of small AAAs as part of a national audit . Methods : ASERNIP-S carried out a prospect i ve audit of EVAR performed between November 1999 and May 2001 in Australia . A total of 478 of the 961 patients entered underwent treatment of a small AAA . Data were collected regarding preoperative characteristics , procedural outcome , and intermediate success . Median follow-up was 3.2 years . Data were analyzed using Kaplan-Meier and Cox proportional hazard analyses . Results : The 30-day mortality and technical success rates were 1.1 % and 98 % , respectively . Postoperative complications occurred in 29 % . Survival was 84 % and 52 % at 3 and 5 years , respectively . Primary , assisted primary , and secondary clinical success rates were 72 % , 79 % , and 82 % , respectively , at 3 years . Reintervention rate was 11 % at 3 years ; however , 15 % of patients continued to have significant aortic sac enlargement . Survival was reduced in patients considered unfit for general anesthesia ( odds ratio = 2.6 ; 95 % confidence interval , 1.4–4.8 , P = 0.002 ) or those who had elevated preoperative serum creatinine ( odds ratio = 2.0 ; 95 % confidence interval , 1.3–3.0 , P = 0.001 ) . Conclusions : EVAR can be carried with good perioperative outcome in patients with small AAA ; however , intermediate success is hampered by the need for reintervention and continued aortic sac enlargement . At present , widespread treatment of small AAAs by EVAR would appear inappropriate OBJECTIVE The purpose of this study was to evaluate the safety and efficacy of a novel endovascular graft for elective treatment of infrarenal abdominal aortic aneurysm . The device is a modular bifurcated system with nitinol/exp and ed polytetrafluoroethylene components and a smaller profile than currently approved devices . METHODS In a multicenter , concurrent controlled phase II trial , 334 patients underwent treatment with the Excluder bifurcated endoprosthesis ( test , n = 235 ; W. L. Gore & Associates , Inc , Sunnyvale , Calif ) or with st and ard open repair ( control , n = 99 ) . Preoperative characteristics , perioperative variables , follow-up clinical evaluations , and radiographic examination results through the first 2 years were analyzed with univariable and multivariable statistics . RESULTS Patients in the test group had less blood loss ( 310 + /- 19 mL versus 1590 + /- 124 mL ; P < .0001 ) , fewer homologous transfusions ( 6 % versus 32 % ; P < .0001 ) , and shorter lengths of stay ( 2.0 + /- 0.1 days versus 9.8 + /- 1.4 days ; P < .0001 ) . Early major adverse events were markedly reduced in the test group ( 14 % versus 57 % ; P < .0001 ) , and this difference persisted at 2 years . No difference was seen in survival rate ( P = .13 ) . In the first 2 years , no deployment failure , early conversion , or aneurysm rupture occurred . At the 2-year timepoint , core laboratory read trunk migration in 1 % , limb migration in 1 % , limb narrowing in 1 % , endoleak in 20 % , and aneurysm growth in 14 % . One wire discontinuity ( 0.6 % ) was identified in a discharge film . A 7 % annual reintervention rate was seen in the test group in the first 2 years . SUMMARY The test device is a safe and effective treatment compared with open surgical repair for infrarenal abdominal aortic aneurysm . The most striking benefits are reduced blood loss , fewer complications , and faster recovery . Two-year survival rate was similar BACKGROUND Acute kidney injury ( AKI ) after surgery is associated with an increased risk of adverse events and death . Atrial natriuretic peptide ( ANP ) dilates the preglomerular renal arteries and inhibits the renin – angiotensin axis . A low-dose ANP infusion increases glomerular filtration rate after cardiovascular surgery , but it is not known whether it reduces the incidence of AKI or the mortality rate . OBJECTIVE To evaluate whether an intravenous ANP infusion prevents AKI in patients undergoing aortic arch surgery requiring hypothermic circulatory arrest . DESIGN A r and omised controlled study . SETTING Operating room and intensive care unit at Kawasaki Saiwai Hospital , Kanagawa , Japan . PATIENTS Forty-two patients with normal preoperative renal function undergoing elective repair of an aortic arch aneurysm . INTERVENTION Patients were assigned r and omly to receive a fixed dose of ANP ( 0.0125 & mgr;g kg−1 min−1 ) or placebo . The infusion was started after induction of anaesthesia and continued for 24 h postoperatively . MAIN OUTCOME MEASURES The primary end-point was the incidence of AKI within 48 h after surgery . RESULTS AKI developed in 30 % of patients who received ANP compared with 73 % of patients who received placebo ( P = 0.014 ) . Intraoperative urine output was almost 1 l greater in patients who received ANP ( 1865 ± 1299 versus 991 ± 480 ml in the control group , P = 0.005 ) . However , there were no differences in mean arterial pressure or number of episodes of hypotension between the groups . Length of hospital and intensive care stays were not significantly different , nor was there a difference in 30-day mortality . No patients required haemodialysis or continuous renal replacement therapy . CONCLUSION We found that an intravenous infusion of ANP at 0.0125 & mgr;g kg−1 min−1 is an effective intervention for reducing the incidence of postoperative AKI , and appears to afford a degree of renal protection during and after cardiovascular surgery . TRIAL REGISTRATION Kawasaki ANP trial , UMIN Clinical Trials Registry ID : BACKGROUND The relationship between numerous risk factors and perioperative mortality after cardiovascular surgery has been studied extensively . While improved perioperative survival and fewer cardiovascular events have been related to statin therapy , its effect on long-term survival after aneurysm repair remains to be eluci date d. The aim of this study is to determine the effect of statin therapy on long-term survival after open and endovascular aneurysm repair and to identify other cardiovascular and patient-related risk factors in this respect . METHODS A post-hoc analysis of a r and omized trial comparing open and endovascular abdominal aortic aneurysm repair was performed . In this multicenter trial , 351 patients were r and omly assigned to undergo either open abdominal aortic aneurysm repair or endovascular repair . Patients who were on lipid-lowering medication at their inclusion in the trial ( n = 135 ) were compared with those who were not ( n = 216 ) . RESULTS During 6 years of follow-up , 118 ( 33.6 % ) patients died after r and omization . Statin therapy , baseline characteristics , Society for Vascular Surgery/International Society for Cardiovascular Surgery risk factors , aneurysm size , re interventions , antiplatelet or anticoagulant agents , and β-blockers were used to identify prognostic factors influencing survival . After identification of significant factors in a Kaplan-Meier analysis , a multivariable Cox regression analysis was applied . Statin therapy at inclusion in the trial was independently associated with better overall survival after open or endovascular aneurysm repair ( hazard ratio [ HR ] , 0.5 ; 95 % confidence interval [ CI ] , 0.3 - 0.8 ; P = .004 ) . Statins were especially associated with fewer cardiovascular deaths ( HR , 0.4 ; 95 % CI , 0.2 - 0.9 ; P = .025 ) . Several risk factors were associated with poor survival after open and endovascular aneurysm repair : age > 70 ( HR , 3.4 ; 95 % CI , 2.2 - 5.0 ; P < .001 ) , a history of cardiac disease at baseline ( HR , 1.9 ; 95 % CI , 1.3 - 2.8 ; P = .001 ) , and moderate/severe tobacco use ( HR , 1.7 ; 95 % CI , 1.2 - 2.5 ; P = .004 ) . Gender , aneurysm size , the need for reintervention , pulmonary disease , renal disease , carotid disease , hypertension , diabetes mellitus , antiplatelet or anticoagulant agents , and β-blockers were not significantly associated with impaired long-term survival ( P > .05 ) . CONCLUSIONS Despite the limitations of a post-hoc analysis of a prospect ively maintained trial , we conclude that statin therapy at the beginning of the trial is independently associated with improved long-term survival after open or endovascular aneurysm repair , while age above 70 years , a history of cardiovascular disease , and tobacco use are associated with decreased long-term survival BACKGROUND Atrial fibrillation ( AF ) continues to be one of the most common cardiac problems , placing an exp and ing burden on the public health system . In several circumstances , AF can increase the risk of stroke and heart failure . Current pharmacologic treatment options are associated with the potential for significant adverse events , which often outweigh the benefits of achieving sinus rhythm . There is evidence to suggest antiarrhythmic benefits of omega-3 polyunsaturated fatty acids ; however , the data are not conclusive . This study is design ed to further assess the effect of prescription omega-3 ethyl esters ( P-OM3 ) in the prevention of recurrent AF in patients with AF without ( significant ) structural heart disease . METHODS This trial is a 6-month r and omized , double-blind , placebo-controlled , parallel- study design . Patients with confirmed symptomatic paroxysmal or persistent AF ( 5:1 ratio ) will be r and omized to receive either 4 g/d P-OM3 ( Lovaza ; GlaxoSmithKline , Research Triangle Park , NC ) or placebo . The primary end point is the first recurrence of symptomatic AF among patients with paroxysmal AF . Secondary end points include the first recurrence of symptomatic AF among all patients . Safety will be assessed regularly . CONCLUSION This is the first r and omized blinded trial to assess the antiarrhythmic effects of 4 g/d P-OM3 in paroxysmal AF
Due to the limited number of included trials , there is insufficient evidence to draw any conclusions about the effectiveness of cardiovascular prophylaxis in reducing mortality and cardiovascular events in people with AAA .
BACKGROUND Pharmacological prophylaxis has been proven to reduce the risk of cardiovascular events in individuals with atherosclerotic occlusive arterial disease .
However , the role of prophylaxis in individuals with abdominal aortic aneurysm ( AAA ) remains unclear .
Several studies have shown that despite successful repair , those people with AAA have a poorer rate of survival than healthy controls .
People with AAA have an increased prevalence of coronary heart disease and risk of cardiovascular events .
Despite this association , little is known about the effectiveness of pharmacological prophylaxis in reducing cardiovascular risk in people with AAA .
This is an up date of a Cochrane review first published in 2014 .
OBJECTIVES To determine the long-term effectiveness of antiplatelet , antihypertensive or lipid-lowering medication in reducing mortality and cardiovascular events in people with abdominal aortic aneurysm ( AAA ) .