What is the recommendation for abdominal aortic aneurysm (AAA) screening in individuals aged 65 to 75 who have a history of smoking (tobacco use) at any point in their lifetime?

From the Guidelines

Men aged 65 to 75 who have ever smoked, even one time in their life, should undergo a one-time abdominal aortic aneurysm (AAA) screening using ultrasonography, as recommended by the U.S. Preventive Services Task Force 1 and the American Heart Association/American College of Cardiology joint committee on clinical practice guidelines 1. This screening is recommended to detect asymptomatic AAA, which can help prevent rupture and associated mortality.

Key Points

• The screening test is a simple, non-invasive ultrasound that takes about 10-15 minutes to perform.
• Women in this age group who have ever smoked and have other risk factors, such as a family history of AAA or other cardiovascular diseases, should also consider screening, although the evidence is not as strong for this group 1.
• If an aneurysm is detected, further evaluation and monitoring will be necessary to determine the best course of treatment, which may include:
  • Watchful waiting
  • Medication to control blood pressure
  • Surgical repair

Benefits of Screening

The benefits of screening for AAA in men aged 65 to 75 who have ever smoked include a reduced risk of AAA-specific mortality, as shown in several randomized controlled trials 1. The European Society of Cardiology also recommends screening for AAA in men aged 65 to 75 who have ever smoked 1.

Harms of Screening

However, screening and early treatment can also lead to important harms, including an increased number of surgeries with associated clinically significant morbidity and mortality, and short-term psychological harms 1. Therefore, the decision to screen should be individualized and take into account the patient's overall health and risk factors.

From the Research

Abdominal Aortic Aneurysm (AAA) Screening Recommendations

The US Preventive Services Task Force (USPSTF) recommends one-time screening for AAA with ultrasonography in men aged 65 to 75 years who have ever smoked 2. This recommendation is based on a review of the evidence on the effectiveness of one-time and repeated screening for AAA, the associated harms of screening, and the benefits and harms of available treatments for small AAAs.

Benefits of Screening

Screening for AAA in men aged 65 to 75 years who have ever smoked is of moderate net benefit, as it can reduce the risk of AAA-related mortality and rupture 2, 3. A meta-analysis of population-based randomized clinical trials estimated that a screening invitation to men 65 years or older was associated with a reduction in AAA-related mortality over 12 to 15 years 3.

Targeted Screening Strategies

Targeted screening strategies, such as selectively targeting high-risk individuals among men aged 65 to 75 years, could be more effective in preventing death from AAA rupture 4. A study found that targeting men who have smoked for 30 years or more, have a history of coronary artery disease, or both, could detect 74% of all AAAs by screening 33% of the population 4.

Sex Differences in AAA Risk

There are sex differences in the association between smoking and AAA risk, with women being more sensitive to current smoking than men 5. The risk of AAA in current smokers with more than 20 pack-years was higher among women than men, and women had a more rapid decline in excess risk after smoking cessation 5.

Key Points

• The USPSTF recommends one-time screening for AAA with ultrasonography in men aged 65 to 75 years who have ever smoked.
• Screening for AAA in men aged 65 to 75 years who have ever smoked is of moderate net benefit.
• Targeted screening strategies could be more effective in preventing death from AAA rupture.
• There are sex differences in the association between smoking and AAA risk, with women being more sensitive to current smoking than men.