Men who undergo repair of an abdominal aortic aneurysm are twice as likely to die within five years of the operation than men without abdominal aortic aneurysms, but women who have the same operation are four times as likely to die within five years than women who don’t have the condition.
That’s the shocking conclusion from the multifaceted paper that was presented at the European Society for Vascular Surgery at its annual meeting in September 2024. The paper was selected as one of the three best original articles by 37 editors and editorial board members of the European Journal of Vascular and Endovascular Surgery. The honor included a cash prize and an invitation to present the work at a special session of Annual Meeting of the European Society for Vascular Surgery in Krakow, Poland.
Among the researchers who contributed to the paper was Jon Matsumura, MD, professor of vascular surgery in the University of Colorado Department of Surgery.
“This is a huge disparity,” Matsumura says. “We have never really studied it, because women have a lower prevalence of aortic aneurysms, so they constitute a small proportion of the patients enrolled in clinical trials.”
An aortic aneurysm is a bulge or ballooning in the aorta, the main artery that carries oxygenated blood from the heart to the body. If not repaired by surgery, they can rupture, causing potentially deadly internal bleeding. After surgery, patients have increased cardiovascular risk that can also lead to death.
Studying the data
As part of their research, Matsumura and his fellow researchers looked at data from three clinical trials aimed at finding medicines to prevent aneurysm growth. Among the facts they uncovered were that women with aortic aneurysms were more likely than their male counterparts to be active smokers, less likely than their male counterparts to be prescribed statins for cholesterol, and less likely to attain the blood pressure goals set by their health providers.
“We know from these subsets that we are undertreating women for cardiovascular risk,” Matsumura says. “They're smoking more often, their blood pressure is more poorly controlled, and they get statins less often.”
An intervention to help
To help solve the problem, Matsumura is now seeking funding to help with the creation of an intervention to help women stop smoking and get their cholesterol and blood pressure under control.
Under his proposed plan, a nurse practitioner, supervised by a vascular medicine specialist, would set up dedicated clinic time to meet with women with aortic aneurysms and put together plans to help them lower their LDL cholesterol and use advanced smoking cessation techniques — including motivational interviewing (a counseling approach that helps people change their behavior by exploring and resolving their ambivalence about change), dose-adjusting older nicotine replacement therapy, prescribing new medications, and starting nicotine replacement therapy before the patient actually quits — to help the women stop smoking.
“We would brand them as aneurysm nurse specialists, and our plan is to randomize clinics of women with aortic aneurysms around the world to six months of this intervention, having a specialized clinician work with them to improve their compliance with clinical guidelines,” he says.
It’s an important problem to address, he says, because women with aneurysms are not only dying of their aneurysms, but they are also dying before their aneurysm gets large enough to indicate a repair, and after successful repair of their aneurysm.
“They are selected less often for repair,” he says. “They are not screened, because the screening studies only show the benefit in men. So they're presenting later, and even after repair, they're dying more often. It's not just the aneurysm, it's the fact that we're not addressing their total health. They die of cancer, heart disease, emphysema, and stroke. If we can address their cardiovascular risk, they would live longer, and there would be a greater benefit of repairing the aneurysm, because it is essentially a preventive procedure.”
Focused care
Soon, Matsumura hopes CU will start a clinic for women with aortic aneurysms to give them care comparable to that of women with potentially deadly cancers and other diseases.
“Women with aortic aneurysms are dying faster than women with advanced colon and breast cancer,” he says. “We have neglected them up until now, and we need to provide them the same multidisciplinary, multispecialty-focused care that we offer so many other patients who have similar dangerous diseases. In the last part of our paper, we used a validated risk score algorithm to calculate the potential to reduce 10-year risk of major adverse cardiovascular events from 43% to 14%.”
