CC BY 4.0 · Aorta (Stamford) 2023; 11(05): 1-18
DOI: 10.1055/s-0044-1787941
IMAD 2024 Meeting Abstracts

Unexplained Finding: More than Halved Aneurysmal Growth Rates in DANCAVAS Trial Compared to the VIVA Trial

Joachim Sejr Skovbo Kristensen
1   Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
2   Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
,
Marie Dahl
2   Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
3   Department of Vascular Surgery, Vascular Research Unit, Viborg Regional Hospital, Viborg, Denmark
4   Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
,
Katrine Lawaetz Larsen
1   Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
,
Axel Cosmus Pyndt Diederichsen
5   Department of Cardiology, Odense University Hospital, Odense, Denmark
,
Jes Sanddal Lindholt
1   Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
2   Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
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Keywords

Abdominal aortic aneurysm - growth rate - progression rate - medication - smoking - diabetes mellitus

Objective: We compared the growth rates between the Viborg Vascular (VIVA) screening trial[1] conducted from 2008 to 2011 and the Danish Cardiovascular screening trial (DANCAVAS)[2] [3] from 2014 to 2017. Additionally, we explored potential explanations for differences in growth rates.

Methods: The two cohorts are both from randomized screening trials of Danish men in the age-group 60-74 years (65-74 for VIVA) with serial measurements of the abdominal aortic aneurysm (AAA). VIVA employed ultrasound, while DANCAVAS utilized non-contrast ECG-gated CT for aortic measurements. Individual linear regression analyses were conducted including each measurement to calculate the growth rate. Multivariate regression adjustment with baseline AAA diameter, current smoking, diabetes, diastolic blood pressure, body mass index, and age was conducted.

Results: In both the VIVA trial (n=439) and DANCAVAS study (n=409), annual growth rates were analyzed, see [Table 1]. The unadjusted growth rates were 3.00 (±2.58) mm/year for VIVA and 1.16 (±1.74) mm/year for DANCAVAS, indicating a relative reduction of approximately 61.33%. Even after adjustment, DANCAVAS showed a significantly lower mean difference in growth rate of -1.68 (±0.15) mm/year compared to VIVA (P<0.001), yielding a 56% relative reduction.

Discussion: The risk reduction and change in proportion of smokers are too small to have caused the difference alone, so it is obvious to consider whether changes in medication could explain it. However, these findings were also negative. These negative observations regarding medication align with findings from the RESCAN study from 2012.[4] Information bias may conceal medication benefits if baseline analysis omits dose equivalence, adherence, and changes.

Conclusion: The DANCAVAS trial revealed a perplexing more than 50% reduction in aneurysmal growth rates compared to the VIVA trial. Investigating this unexplained phenomenon holds the potential to enhance our understanding of AAA pathophysiology and may offer insights into novel treatment approaches.

Table 1

Smoking, diabetes, and medications in men with abdominal aortic aneurysm undergoing surveillance from the VIVA or DANCAVAS trials and their association with baseline AAA size and aneurysmal growth rate

N (%)

Size of aneurysm at baseline mm (SD)

Growth rate of aneurysmmm/year (SD)

Adjusted mean difference[***]MD (S.E.D)

Exposed

Unexposed

Exposed

Unexposed

Exposed

Unexposed

DANCAVAS (n=409)

-

-

Smoking

138 (33.7)

270 (66.0)

37.0 (6.35)

36.4 (6.14)

1.43 (1.80)

0.99 (1.62)[*]

0.42 (18.2)[*]

Diabetes mellitus

60 (14.7)

349 (85.3)

37.0 (6.59)

36.5 (6.14)

1.20 (1.71)

1.72 (1.85)[*]

-0.23 (0.22)

Oral antidiabetics[**]

43 (71.7)

17 (28.3)

38.2 (6.61)

34.0 (5.73)

0.96 (1.67)

0.77 (1.97)

0.26 (0.52)

Oral glucocorticoid

8 (2.0)

401 (98)

35.5 (6,35)

36.6 (6.21)

1.11 (1.83)

0.94 (1.09)

0.12 (0.64)

Beta-agonist

25 (6.1)

384 (93.9)

36.0 (4.95)

36.3 (5.37)

0.99 (1.32)

1.12 (1.85)

- 0.05 (0.37)

Anticoagulants

39 (9.5)

370 (90.5)

37.0 (6.57)

36.5 (6.18)

1.22 (1.97)

1.15 (1.71)

0.15 (0.27)

Platelet inhibitor

176 (43)

233 (57)

37.9 (6.70)

35.6 (5.61)[*]

1.36 (1.73)

1.00 (1.73)[*]

0.20 (0.16)

Beta-blockers

102 (24.9)

307 (75.1)

37.2 (6.38)

36.4 (6.15)

1.06 (2.24)

1.13 (1.66)

-0.11 (0.29)

Ace-inhibitors

197 (48.2)

212 (51.8)

36.5 (6.32)

36.7 (6.12)

1.08 (1.77)

1.14 (1.86)

- 0.03 (0.18)

Calcium channel blockers

112 (27.4)

297 (72.6)

37.3 (6.42)

36.3 (6.11)

1.04 (1.56)

1.14 (1.91)

- 0.02 (0.20)

Statins

201 (49.1)

208 (50.9)

37.1 (6.52)

36.1 (3.43)

1.16 (1.80)

1.06 (1.80)

0.19 (0.18)

NSAID

18 (4.4)

391 (95.6)

39.4 (7.54)

36.5 (6.12)

1.85 (2.20)

1.12 (1.71)[*]

0.42 (0.38)

VIVA (n=439)

Smoking

252 (57.4)

182 (41.5)

36.1 (5.15)

36.5 (5.50)

3.48 (2.94)

2.60 (2.19)

0.75 (0.25)[*]

Diabetes

41 (9.3)

397 (90.4)

35.9 (5.10)

36.3 (5.39)

1.96 (1.58)

3.11 (2.64)[*]

-0.70 (0.41)

Oral antidiabetics[**]

20 (48.8)

20 (48.8)

36.5 (5.67)

35.6 (4.60)

2.02 (1.05)

1.85 (2.02)

0.01 (0.54)

Oral gluccocorticoid

9 (2.1)

417 (95)

38.8 (5.78)

36.2 (5.31)

5.23 (4.60)

2.91 (2.50)

2.69 (0.84)

Beta-agonist

25 (5.7)

401 (91.3)

36.0 (4.95)

36.3 (5.36)

2.71 (3.30)

3.01 (2.54)

- 0.23 (0.53)

Platelet inhibitor

212 (48.3)

224 (51)

36.4 (5.40)

36.2 (5.33)

2.71 (2.40)

3.28 (2.73)

- 0.15 (0.25)

Anticoagulants

29 (6.6)

400 (91.1)

36.4 (6.04)

36.3 (5.29)

3.51 (3.71)

2.95 (2.49)

1.14 (0.48)[*]

Beta-blockers

116 (26.4)

313 (71.3)

35.6 (5.41)

36.5 (5.30)

2.71 (2.11)

3.11 (2.74)

-0.11 (0.29)

Ace-inhibitors

111 (25.3)

321 (73.1)

36.7 (5.95)

36.1 (5.16)

2.83 (2.19)

3.05 (2.71)

- 0.88 (0.30)

Calcium channel blockers

108 (24.6)

322 (73.3)

36.5 (5.41)

36.2 (5.36)

2.77 (2.80)

3.07 (2.50)

- 0.05 (0.29)

Statins

232 (52.8)

200 (45.6)

36.5 (5.48)

36.0 (5.20)

2.73 (2.28)

3.28 (2.88)

0.22 (0.26)

NSAID

18 (4.1)

409 (93.2)

35.7 (4.67)

36.3 (5.37)

2.23 (1.89)

3.02 (2.61)

-0.82 (0.58)

* P<0.05


** only diabetics


*** Adjusted for baseline AAA diameter, current smoking, diabetes, diastolic blood pressure, body mass index, and age



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  • References

  • 1 Grøndal N, Søgaard R, Lindholt JS. Baseline prevalence of abdominal aortic aneurysm, peripheral arterial disease and hypertension in men aged 65-74 years from a population screening study (VIVA trial). Br J Surg 2015;102(8):902–906
    PubMed
  • 2 Lindholt JS, Søgaard R, Rasmussen LM, et al. Five-Year Outcomes of the Danish Cardiovascular Screening (DANCAVAS) Trial. N Engl J Med 2022;387(15):1385–1394
    PubMed
  • 3 Obel LM, Diederichsen AC, Steffensen FH, et al. Population-Based Risk Factors for Ascending, Arch, Descending, and Abdominal Aortic Dilations for 60-74-Year-Old Individuals. J Am Coll Cardiol 2021;78(3):201–211
    PubMed
  • 4 Sweeting MJ, Thompson SG, Brown LC, Powell JT; RESCAN collaborators. Meta-analysis of individual patient data to examine factors affecting growth and rupture of small abdominal aortic aneurysms. Br J Surg 2012;99(5):655–665
    PubMed

Corresponding author

Joachim Sejr Skovbo Kristensen

Publikationsverlauf

Artikel online veröffentlicht:
11. Juni 2024

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  • References

  • 1 Grøndal N, Søgaard R, Lindholt JS. Baseline prevalence of abdominal aortic aneurysm, peripheral arterial disease and hypertension in men aged 65-74 years from a population screening study (VIVA trial). Br J Surg 2015;102(8):902–906
    PubMed
  • 2 Lindholt JS, Søgaard R, Rasmussen LM, et al. Five-Year Outcomes of the Danish Cardiovascular Screening (DANCAVAS) Trial. N Engl J Med 2022;387(15):1385–1394
    PubMed
  • 3 Obel LM, Diederichsen AC, Steffensen FH, et al. Population-Based Risk Factors for Ascending, Arch, Descending, and Abdominal Aortic Dilations for 60-74-Year-Old Individuals. J Am Coll Cardiol 2021;78(3):201–211
    PubMed
  • 4 Sweeting MJ, Thompson SG, Brown LC, Powell JT; RESCAN collaborators. Meta-analysis of individual patient data to examine factors affecting growth and rupture of small abdominal aortic aneurysms. Br J Surg 2012;99(5):655–665
    PubMed