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Raised abdominal aortic aneurysm risk in female smokers

By Emma Wilkinson

Women who smoke are four times more likely to have an abdominal aortic aneurysm (AAA) repair or rupture as women who have quit smoking, and are eight times more likely than women who have never smoked, results from the Women's Health Initiative show.

In women who have ever smoked more than 100 cigarettes the risk of an aortic aneurysm remains double even if they no longer smoke, the researchers reported in the BMJ.

The results – similar to the risks already reported in men – also showed age was associated with increased risk and diabetes had a negative association.

And the findings raise the issue of whether the screening programme should be widened to include women, or women who smoke.

Pilots of a UK screening programme are currently focusing on men over the age of 65 years.

Most studies to date have focused on men and have included too few women to get reliable data on risk factors in women, the US researchers said.

A total of 161,808 postmenopausal women were followed for eight years in the study.

There were 184 reported abdominal aneurysm events repairs or ruptures during follow up.

The study also showed that HRT provided protection against aortic aneurysm – contradicting previous research, which suggested oestrogen therapy alone may increase the risk.

Professor Janet Powell from the Vascular Surgery Research Group, at Imperial College London, said financial restraints prevented high-risk women from being added to the current programme but that might have to be reconsidered in the future.

‘If the prevalence of smoking does not decline, it is possible that in 10 or more years time it might be prudent to screen women smokers.'

Dr Sarah Jarvis, RCGP spokeswomen on women's health and a GP in Shepherd's Bush, west London, said the results pointed toward a need for targeting older women smokers at risk of AAA.

‘It may be an argument for introducing it in women smokers, since if their incidence is 4 times higher than that of non smoking women, it may approach that of men. However, I would suggest it is another very strong argument for continuing to target older women smokers. I'd like to see a screening study which separated out the incidence in smokers versus non smokers in both men and women - I think that would be very telling.'

Screening gap?

It emerged in January that men in England are to be offered screening for abdominal aortic aneurysm, the third most common cause of death among older men.

Over the next five years, ultrasound scan screening will be rolled out across 60 centres to cover all men aged 65 and over.

But the new research shows that of 161,808 postmenopausal women there were 184 abdominal aneurysm events, with the risk much higher for smokers.

Arteriograph showing abdominal aortic aneurysm Arteriograph showing abdominal aortic aneurysm

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