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Background:

The Västerbotten County in Northern Sweden, and particularly Norsjö municipality, has historically had a high burden of cardiovascular disease, and abdominal aortic aneurysm (AAA).

Aims:

To investigate aspects of aneurysm epidemiology in a population with historically high cardiovascular disease and AAA incidence; specifically:(I)to study the AAA prevalence and associated risk factors in a high-risk population;(II)to study popliteal artery diameter and prevalence of popliteal artery aneurysm (PAA) in a high-risk population;(III) to study risk factors associated with the development of AAA and thoracic aortic aneurysm (TAA);(IV)to study dietary factors and risk for development of AAA and TAA.

Methods & Results:

Population-based screening in Norsjö (ages 65–75) showed a significant decline in AAA prevalence among men (16.9% in 1999 → 5.7% in 2010) and a nonsignificant decline in women (3.5% → 1.1%). Compared to 1999, lipid profiles, BMI, and blood pressure control improved, while smoking remained unchanged at low levels. PAA prevalence ≥12 mm was 3.8% in men and 0% in women; most were small and benign with slow growth rates. In a population-based case-control study, using the prospective VIP/MONICA cohort 1985–2010, smoking, hypertension, hyperlipidemia, and coronary artery disease were significantly associated with later AAA development, while only hypertension was associated with TAA development. In the same case-control cohorts, a weak inverse association between AAA and adherence to a Mediterranean diet or high fruit/vegetable intake was observed.

Conclusion:

The sharp decline in AAA prevalence in Norsjö was mainly attributed to improved cardiovascular risk factors, including diet, rather than smoking habits (as suggested in the literature). AAA and TAA show distinct risk factor profiles, indicating partly different etiologies. PAA is rare, and small screening-detected PAAs appear largely benign.