Women smokers may have same risk for deadly aneurysm as men

Women who smoke cigarettes are just as likely as men to develop potentially fatal aneurysms in the main artery leading from the heart, according to a recent study.

Guidelines already recommend screening men over age 65 who have ever smoked for abdominal aortic aneurysm, a life-threatening condition, but it may be time to give women the same advice, the authors say.

“Smoking is a major risk factor for abdominal aortic aneurysm (AAA) and the risk appears to be as strong among women,” said lead author Dr. Eiman Jahangir, a senior lecturer with the University of Queensland School of Medicine-Ochsner Clinical School program in New Orleans.

AAA occurs when a person’s aorta, the biggest blood vessel in the body, swells to a larger size. The aorta runs from the heart through the abdomen delivering blood to much of the body.

Symptoms of an abdominal aortic aneurysm may include a pulsing feeling, swelling or pain in the stomach area.

While the condition can be treated with surgery, “the risk is that they can continue to grow and burst, which is usually fatal,” said Dr. Vimal Gokani, a clinical research fellow at the British Heart Foundation in London who was not involved in the study.

Most cases of aneurysm occur in people over 65 and Gokani noted in an email that as the population ages, the problem is likely to become more common.

According to the Centers for Disease Control and Prevention, more than 10,000 people in the U.S. die each year from AAA. Jahangir and colleagues write in the Journal of Epidemiology and Community Health that it’s the 16th leading cause of death for seniors.

The study team analyzed data from a long term study of people in the U.S. South. They focused on a total of 18,792 participants who were over 65 and had Medicare coverage. Participants answered questionnaires including information about demographics, tobacco use and personal and family health histories.

The researchers compared this information with Medicare records to determine that 281 people had suffered aneurysms during the study period.

Men were twice as likely as women to have aneurysms and whites were 2.5 times more likely than blacks to experience the condition.

Smoking was the strongest risk factor, however, with former smokers – both men and women - facing almost twice the risk of never smokers, and current smokers facing an overall risk five and a half times that of never smokers.

The difference smoking made was especially pronounced among women, with former smokers having three and a half times the risk of women who had never smoked and current smokers having nine times the risk of women who had never smoked.

The researchers note that this is problematic, as aneurysms are more often severe when they happen to women.

Having high blood pressure or a history of heart surgery also increased the risk of aneurysm, while being overweight was linked to a lowered risk. Gokani noted that having a family history of aneurysm and high cholesterol can also increase a person’s risk.

Currently, men between the ages of 65 and 75 who have ever smoked are advised to have a one-time screening ultrasound to check for aneurysm, according to Jahangir. He said that women are not currently included in these recommendations and “more studies need to be done to see if women would also benefit from screening ultrasound for AAA.”

Both Jahangir and Gokani said that quitting smoking will likely reduce the risk of aneurysm. “Smoking cessation is very difficult, but so important,” Gokani said.

He cited recent research showing that when smoking rates in a country are lowered, the rates of aneurysm go down as well.

Jahangir advises men ages 65-75 who have ever smoked to get an abdominal ultrasound and advises women to talk to their doctors about whether a screening is recommended.

If an aneurysm is found, Gokani recommends that people should stop smoking and “seek medical advice to ensure that their blood pressure is under control, that their cholesterol levels are normal.”