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A Population Based Case-Control Study of Familial Risk Of Aortic Aneurysms

Emma Larsson1, Fredrik Granath2, Rebecka Hultgren1, Jesper Swedenborg.1
1Karolinska Institutet, Stockholm, Sweden;2Department for Epidemiology, Karolinska Institutet, Stockholm, Sweden.

OBJECTIVES: The true risk to develop aneurysms for first degree relatives of patients with abdominal aortic aneurysms (AAA) is poorly investigated. To better understand a hereditary pattern, we investigated all persons and their first degree relatives diagnosed with AAA in Sweden, and compared them with matched controls and their relatives.

METHODS: All persons (3,245) born after 1932 and diagnosed with AAA 2001-2005 were identified in the Swedish National Hospital Discharge or Cause of Death registers. A random selection of 28,245 matched controls was extracted from the Register of total population. First degree relatives of cases and controls were identified via the multi-generation register. Family history of aortic aneurysm for cases and controls was assessed by linking the relatives to the hospital discharge register and Cause of Death register. The case control study was then analyzed by conditional logistic regression.

RESULTS: The odds ratio of having AAA with one relative with AAA; compared to none was 1.9 (95%CI: 1.7-2.2), with two or more relatives it was 6.4 (95%CI: 3.4-12.0). No significant differences in familial risk were seen between male; 1.9 (95%CI: 1.6-2.1) and female cases; 2.1 (95%CI: 1.5-3.1. The relative risk was 3.3 (1.3-8.5) if the patient was younger than 50 years of age, and 2.0 (1.7-2.3) for patients older than 50. The relative risk associated with family history for thoracic and thoraco-abdominal aneurysms was similar: 2.1 (95%CI: 1.8-2.4), 6.0 (95%CI: 3.4-10.7) for one and two affected relatives respectively.

CONCLUSIONS: In this nationwide survey, the risk to develop AAA is shown to be at least doubled for first degree relatives to persons diagnosed with AAA. The risk increases if the patient has several relatives with AAA and if the aneurysm is diagnosed in early age, but gender does not influence the risk. The increased risk with several relatives is compatible with a multigenetic pathogenesis. The risk may be underestimated due to unreported cases with ruptured aortic aneurysms and unrecognized relatives.
AUTHOR DISCLOSURES: E. Larsson, None; F. Granath, None; R. Hultgren, The Swedish Heart and Lung Foundation, The Karolinska Institutet, European Society of Vascular and Endovascular Surgery (ESVS); J. Swedenborg, The Swedish Heart and Lung Foundation, The Karolinska Institutet.