Association of chronic obstructive pulmonary, coronary artery, or peripheral artery disease with abdominal aortic aneurysm rupture

BACKGROUND: Chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), and peripheral artery disease (PAD) are positively associated with abdominal aortic aneurysm (AAA) presence. It remains unclear, however, whether these 3 comorbidities are associated with AAA rupture. To assess the association of COPD, CAD, or PAD with AAA rupture, we reviewed currently available studies with a systematic literature search and meta-analytic estimates. METHODS: Databases including MEDLINE and EMBASE were searched through December 2015 using PubMed and OVID. For each study, data regarding prevalence of COPD, CAD, or PAD in both the ruptured and non-ruptured groups were used to generate odds ratios (ORs) for rupture and 95% confidence intervals (CIs). Study-specific estimates were combined using inverse variance-weighted averages of logarithmic ORs in a random-effects model. RESULTS: Our search identified 9 relevant studies including data on a total of 8873 AAA patients (rupture, 1241; non-rupture, 7632). Pooled analyses demonstrated that COPD was significantly and positively (OR, 1.51; 95% CI, 1.06 to 2.16; P=0.02), CAD was not significantly (OR, 0.83; 95% CI, 0.43 to 1.60; P=0.58), and PAD tended to be negatively (though non-significantly) associated with AAA rupture (OR, 0.44; 95% CI, 0.16 to 1.23; P=0.12). CONCLUSIONS: Our analysis suggests that COPD is positively associated with AAA rupture, CAD is not associated with it, and PAD tends to be negatively associated with it. Further investigations would be required to understand precise mechanisms regarding the association of COPD, CAD, and PAD with AAA presence, growth, and rupture.