Education and information to reduce aortic aneurysm mortality rates

We would like to congratulate Pham et al.1 for their important study. The authors analysed aortic examination by computed tomography angiography in 11 294 individuals from the Copenhagen General Population Study. The prevalence of aortic aneurysms was 2.1% (men 4.0%; women 0.7%). The prevalence of aortic aneurysms was statistically correlated with male sex, increasing age, and body surface area. Thoracic aortic aneurysm prevalence was statistically correlated with arterial hypertension, whereas abdominal aortic aneurysm was correlated with hypercholesterolaemia and smoking. We analysed data of 33 European countries,2 confirming the correlation between sex, smoking, arterial hypertension, high caloric diet, and aortic aneurysm-related age-standardized mortality rates (AA-ASMRs).3,4 The higher the Socio-demographic Index (SDI), the higher the AA-ASMR. We found that AA-ASMR was higher in Northern European countries (P < 0.001) than in Central and Southern European countries (Figure 1). There was a significant difference in the correlation between health spending and trends of AA-ASMR in the periods 1980–2000 and 2000–19. Despite increasing health spending, AA-ASMR increased in the period 1980–2000 in most European countries with high SDI. In the period 2000–19, there was a statistically significant correlation between levels of health spending and reduced AA-ASMR. In the period 2000–19, health spending included a higher percentage devoted to preventive care, education, and counselling programmes.5 Another important matter to consider is the increasing use of aspirin, statins, and beta-blockers in the period 2000–19. These changes were more evident in countries with high SDI and higher AA-ASMR, conceptually explaining the reduced exposure to specific risk factors like arterial hypertension, smoking, and high cholesterol in several countries. Thus, the higher the AA-ASMR and burden of aortic aneurysm and cardiovascular diseases with awareness for the general population and for national organizations, the more significant the changes in type of health spending with increasing expenditure for preventive care, for education and information, and for the use of aspirin, statins, and control of arterial hypertension. This evidence introduces the matter that often medical problems are not prevented and are considered only when they represent a threat to the general population. Age standardized. ASMRs (×100 000) related with aortic aneurysm in Europe in 1980 (A) and in 2019 (B).6 ASMR related with aortic aneurysm in Europe is higher in Northern European countries. In the last 39 years, there has been a significant decrease of ASMR related with aortic aneurysm thanks also to improved levels of education and information, diffuse use of statins and aspirin, and better control of arterial hypertension. This decrease has been more evident in Northern European countries. It is evident that lifestyle may influence AA-ASMR significantly and that we may expect, as reported by Pham et al., an increase in AA-ASMR with improved SDI and associated changes of lifestyle in several countries, including high caloric diet with consequent increase of obesity and arterial hypertension. Expenditure for education and information has a fundamental role. In countries with high SDI appropriate expenditure for eductaion and information allows the persistence of the trend of the last 20 years towards reduced AA-ASMR; in countries with increasing SDI, allows to prevent some of the negative effects of changing lifestyles. These observations on AA-ASMR may be extended to other cardiovascular diseases including ischaemic stroke and myocardial infarction. None declared. Data are available from A.V.S. ([email protected]).