#Fluoroquinolone use and risk of aortic #aneurysm and dissection: nationwide cohort study
http://www.bmj.com/content/360/bmj.k678
Within the 60 day risk period, the rate of aortic aneurysm or dissection was 1.2 cases per 1000 person years among fluoroquinolone users and 0.7 cases per 1000 person years among amoxicillin users. Fluoroquinolone use was associated with an increased risk of aortic aneurysm or dissection (hazard ratio 1.66 (95% confidence interval 1.12 to 2.46)), with an estimated absolute difference of 82 (95% confidence interval 15 to 181) cases of aortic aneurysm or dissection by 60 days per 1 million treatment episodes. In a secondary analysis, the hazard ratio for the association with fluoroquinolone use was 1.90 (1.22 to 2.96) for aortic aneurysm and 0.93 (0.38 to 2.29) for aortic dissection.
Conclusions In a propensity score matched cohort, fluoroquinolone use was associated with an increased risk of aortic aneurysm or dissection. This association appeared to be largely driven by aortic aneurysm
http://www.bmj.com/content/360/bmj.k678
Within the 60 day risk period, the rate of aortic aneurysm or dissection was 1.2 cases per 1000 person years among fluoroquinolone users and 0.7 cases per 1000 person years among amoxicillin users. Fluoroquinolone use was associated with an increased risk of aortic aneurysm or dissection (hazard ratio 1.66 (95% confidence interval 1.12 to 2.46)), with an estimated absolute difference of 82 (95% confidence interval 15 to 181) cases of aortic aneurysm or dissection by 60 days per 1 million treatment episodes. In a secondary analysis, the hazard ratio for the association with fluoroquinolone use was 1.90 (1.22 to 2.96) for aortic aneurysm and 0.93 (0.38 to 2.29) for aortic dissection.
Conclusions In a propensity score matched cohort, fluoroquinolone use was associated with an increased risk of aortic aneurysm or dissection. This association appeared to be largely driven by aortic aneurysm
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Benefits and harms of #screening men for abdominal aortic #aneurysm in Sweden: a registry-based cohort study
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31031-6/fulltext
AAA mortality in Swedish men has decreased from 36 to ten deaths per 100 000 men aged 65–74 years between the early 2000s and 2015. Mortality decreased at similar rates in all Swedish counties, irrespective of whether AAA screening was offered. After 6 years with screening, we found a non-significant reduction in AAA mortality associated with screening (adjusted odds ratio aOR 0·76, 95% CI 0·38–1·51), which means that two men (95% CI −3 to 7) avoid death from AAA for every 10 000 men offered screening. Screening was associated with increased odds of AAA diagnosis (aOR 1·52, 95% CI 1·16–1·99; p=0·002) and an increased risk of elective surgery (aOR 1·59, 95% CI 1·20–2·10; p=0·001), such that for every 10 000 men offered screening, 49 men (95% CI 25–73) were likely to be overdiagnosed, 19 of whom (95% CI 1–37) had avoidable surgery that increased their risk of mortality and morbidity.
Interpretation
AAA screening in Sweden did not contribute substantially to the large observed reductions in AAA mortality. The reductions were mostly caused by other factors, probably reduced smoking. The small benefit and substantially less favourable benefit-to-harm balance call the continued justification of the intervention into question
Benefits and harms of #screening men for abdominal aortic #aneurysm in Sweden: a registry-based cohort study
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31031-6/fulltext
AAA mortality in Swedish men has decreased from 36 to ten deaths per 100 000 men aged 65–74 years between the early 2000s and 2015. Mortality decreased at similar rates in all Swedish counties, irrespective of whether AAA screening was offered. After 6 years with screening, we found a non-significant reduction in AAA mortality associated with screening (adjusted odds ratio aOR 0·76, 95% CI 0·38–1·51), which means that two men (95% CI −3 to 7) avoid death from AAA for every 10 000 men offered screening. Screening was associated with increased odds of AAA diagnosis (aOR 1·52, 95% CI 1·16–1·99; p=0·002) and an increased risk of elective surgery (aOR 1·59, 95% CI 1·20–2·10; p=0·001), such that for every 10 000 men offered screening, 49 men (95% CI 25–73) were likely to be overdiagnosed, 19 of whom (95% CI 1–37) had avoidable surgery that increased their risk of mortality and morbidity.
Interpretation
AAA screening in Sweden did not contribute substantially to the large observed reductions in AAA mortality. The reductions were mostly caused by other factors, probably reduced smoking. The small benefit and substantially less favourable benefit-to-harm balance call the continued justification of the intervention into question
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Genome-Wide Expression Profiling Unveils Autoimmune Response Signatures in the #Perivascular Adipose Tissue of Abdominal Aortic #Aneurysm
https://www.ahajournals.org/doi/10.1161/ATVBAHA.118.311803
Perivascular adipose tissue (PVAT) is thought to play a role in vascular homeostasis and in the pathogenesis of large vessel diseases, including abdominal aortic aneurysm (AAA). Herein, we tested the hypothesis that locally restricted transcriptional profiles characterize PVAT surrounding AAA, indicating specific dysfunctions associated with the disease.
..both innate and adaptive immune-response genes along with genes related to cell-death pathways, metabolic processes of collagen, sphingolipids, aminoglycans, and extracellular matrix degradation were strongly overrepresented in PVAT of AAA compared with PVAT of the not-dilated aorta.
Conclusions—
Our results support a possible function of PVAT in AAA pathogenesis and suggest that AAA is an immunologic disease with an underlying autoimmune component. Interfering with these disease-specific pathways would clarify their precise role in AAA pathogenesis.
Genome-Wide Expression Profiling Unveils Autoimmune Response Signatures in the #Perivascular Adipose Tissue of Abdominal Aortic #Aneurysm
https://www.ahajournals.org/doi/10.1161/ATVBAHA.118.311803
Perivascular adipose tissue (PVAT) is thought to play a role in vascular homeostasis and in the pathogenesis of large vessel diseases, including abdominal aortic aneurysm (AAA). Herein, we tested the hypothesis that locally restricted transcriptional profiles characterize PVAT surrounding AAA, indicating specific dysfunctions associated with the disease.
..both innate and adaptive immune-response genes along with genes related to cell-death pathways, metabolic processes of collagen, sphingolipids, aminoglycans, and extracellular matrix degradation were strongly overrepresented in PVAT of AAA compared with PVAT of the not-dilated aorta.
Conclusions—
Our results support a possible function of PVAT in AAA pathogenesis and suggest that AAA is an immunologic disease with an underlying autoimmune component. Interfering with these disease-specific pathways would clarify their precise role in AAA pathogenesis.
Association of Infections and Use of #Fluoroquinolones With the Risk of Aortic #Aneurysm or Aortic Dissection
https://2medical.news/2020/09/13/association-of-infections-and-use-of-fluoroquinolones-with-the-risk-of-aortic-aneurysm-or-aortic-dissection/
Prior observational studies have suggested that fluoroquinolone use may be associated with more than 2-fold increased risk of aortic aneurysm or aortic dissection (AA/AD). These studies, however, did not fully consider the role of coexisting infections and the risk of fluoroquinolones relative to other antibiotics.. .. A total of 28 948 cases and 289 480 matched controls were included (71.37% male; mean [SD] age, 67.41 [15.03] years). …
https://2medical.news/2020/09/13/association-of-infections-and-use-of-fluoroquinolones-with-the-risk-of-aortic-aneurysm-or-aortic-dissection/
Prior observational studies have suggested that fluoroquinolone use may be associated with more than 2-fold increased risk of aortic aneurysm or aortic dissection (AA/AD). These studies, however, did not fully consider the role of coexisting infections and the risk of fluoroquinolones relative to other antibiotics.. .. A total of 28 948 cases and 289 480 matched controls were included (71.37% male; mean [SD] age, 67.41 [15.03] years). …
Association of #Fluoroquinolone Use With Short-term Risk of Development of Aortic #Aneurysm
https://2medical.news/2021/01/09/association-of-fluoroquinolone-use-with-short-term-risk-of-development-of-aortic-aneurysm/
Although fluoroquinolones are commonly prescribed antibiotics in the US, recent international studies have shown an increased risk of aortic aneurysm and dissection after fluoroquinolone use, leading to US Food and Drug Administration warnings limiting use for high-risk patients. It is unclear whether these data are true for the US population and who is truly high risk.. ..Of 47 596 545 prescription fills, 9 053 961 (19%) were fluoroquinolones and …
https://2medical.news/2021/01/09/association-of-fluoroquinolone-use-with-short-term-risk-of-development-of-aortic-aneurysm/
Although fluoroquinolones are commonly prescribed antibiotics in the US, recent international studies have shown an increased risk of aortic aneurysm and dissection after fluoroquinolone use, leading to US Food and Drug Administration warnings limiting use for high-risk patients. It is unclear whether these data are true for the US population and who is truly high risk.. ..Of 47 596 545 prescription fills, 9 053 961 (19%) were fluoroquinolones and …