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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El aneurisma de aorta abdominal &#40;AAA&#41; es una dilataci&#243;n del espesor completo del di&#225;metro de la arteria que es al menos el 50&#37; de su di&#225;metro normal&#44; medido en el plano anteroposterior&#46; En hombres&#44; se define por un di&#225;metro mayor o igual a 3<span class="elsevierStyleHsp" style=""></span>cm<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">1</span></a>&#46; En el 85&#37; de los casos el AAA ocurre en el segmento infrarrenal<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">2</span></a>&#46; La prevalencia ha disminuido de forma importante en los &#250;ltimos a&#241;os hasta situarse en el 2&#44;2&#37;&#44; seg&#250;n los datos obtenidos en programas de cribado realizados a hombres mayores de 65<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46; Este cambio epidemiol&#243;gico probablemente se relacione con el descenso en el consumo de tabaco<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; La rotura del AAA es responsable del 1-2&#37; de todas las muertes en varones de 65 a 85<span class="elsevierStyleHsp" style=""></span>a&#241;os en los pa&#237;ses desarrollados<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">3-6</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Los factores de riesgo que m&#225;s se relacionan con el desarrollo de AAA son el tabaquismo&#44; la edad avanzada&#44; el sexo masculino&#44; la hipertensi&#243;n arterial &#40;HTA&#41;&#44; la hipercolesterolemia y la historia familiar&#46; Por el contrario&#44; la diabetes mellitus se ha relacionado con un menor riesgo para su desarrollo<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">7&#44;8</span></a>&#46; Existen otros factores&#44; como enfermedades hereditarias del tejido conectivo &#40;s&#237;ndrome de Marfan y s&#237;ndrome de Ehlers-Danlos&#41;&#44; esclerosis tuberosa o vasculitis&#44; que son menos frecuentes y se asocian con AAA en pacientes j&#243;venes<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#44;9</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En algunos pa&#237;ses se recomienda el cribado de AAA en varones con edades comprendidas entre 65 y 75<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; sobre todo si tienen historia de tabaquismo<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">10-14</span></a>&#46; Sin embargo&#44; estudios recientes han puesto en cuesti&#243;n la utilidad real de un cribado universal de AAA en pacientes de alto riesgo<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">15</span></a>&#46; La mayor parte de los AAA diagnosticados en los programas de detecci&#243;n son de peque&#241;o tama&#241;o &#40;3-4<span class="elsevierStyleHsp" style=""></span>cm de di&#225;metro m&#225;ximo&#41; y no precisan reparaci&#243;n quir&#250;rgica de forma inminente&#44; ya que el riesgo de rotura es muy bajo &#40;&#8804;<span class="elsevierStyleHsp" style=""></span>1&#37; anual en AAA inferiores a 5&#44;5<span class="elsevierStyleHsp" style=""></span>cm&#41;&#59; sin embargo&#44; a lo largo del tiempo el tama&#241;o del AAA puede aumentar&#44; con el consiguiente incremento del riesgo anual de rotura &#40;9&#44;4&#37; en AAA entre 5&#44;5 y 5&#44;9<span class="elsevierStyleHsp" style=""></span>cm&#44; 10&#44;2&#37; en AAA entre 6&#44;0 y 6&#44;9<span class="elsevierStyleHsp" style=""></span>cm y 32&#44;5&#37; en AAA &#8805;<span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>cm&#41;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">2&#44;16&#44;17</span></a>&#46; Estudios m&#225;s recientes han notificado&#44; no obstante&#44; datos sobre el riesgo de rotura bastante inferiores a los citados anteriormente &#40;3&#44;5&#37; en AAA entre 5&#44;5 y 6&#44;0<span class="elsevierStyleHsp" style=""></span>cm&#44; 4&#44;1&#37; en AAA entre 6&#44;1 y 7<span class="elsevierStyleHsp" style=""></span>cm y 6&#44;3&#37; en AAA &#62;<span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>cm&#41;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">18&#44;19</span></a>&#44; por lo que resulta significativo que los cambios en el comportamiento del paciente en cuanto al control de factores de riesgo se traducen en una disminuci&#243;n de la mortalidad relacionada con el AAA&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">De forma independiente a la relaci&#243;n entre el tama&#241;o del AAA y su riesgo de rotura&#44; en diversos estudios se ha objetivado un mayor riesgo cardiovascular en estos pacientes<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">20-22</span></a>&#46; Se ha sugerido una posible asociaci&#243;n entre el di&#225;metro de la aorta abdominal y el riesgo de muerte&#44; aunque no se alcancen los 3<span class="elsevierStyleHsp" style=""></span>cm de di&#225;metro&#44; al igual que un mayor riesgo de desarrollar AAA en los pacientes con dilataciones subaneurism&#225;ticas<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">23-25</span></a>&#46; As&#237;&#44; la mortalidad en un estudio de cohortes prospectivo de m&#225;s de 7<span class="elsevierStyleHsp" style=""></span>a&#241;os de duraci&#243;n fue significativamente superior entre los varones con un di&#225;metro de la aorta abdominal comprendido entre 2&#44;5 y 2&#44;9<span class="elsevierStyleHsp" style=""></span>cm respecto a un di&#225;metro &#60;<span class="elsevierStyleHsp" style=""></span>2&#44;4<span class="elsevierStyleHsp" style=""></span>cm &#40;10&#44;3&#37; frente a 7&#44;2&#37;&#41;&#59; cuando el tama&#241;o de la aorta super&#243; los 3<span class="elsevierStyleHsp" style=""></span>cm&#44; la mortalidad aument&#243; al 17&#44;6&#37;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">23</span></a>&#46; Por tanto&#44; cabe la posibilidad de considerar el tama&#241;o de la aorta abdominal como un potencial marcador de riesgo cardiovascular&#44; pudiendo a&#241;adirse a las denominadas lesiones de &#243;rgano diana&#44; que determinan la existencia de da&#241;o subcl&#237;nico y se relacionan claramente con un mayor riesgo de complicaciones cardiovasculares&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Gracias a los avances tecnol&#243;gicos&#44; en los &#250;ltimos a&#241;os se han desarrollado ec&#243;grafos de gran calidad a precios asequibles&#44; port&#225;tiles o de bolsillo&#44; que permiten realizar las exploraciones a pie de cama o en la propia consulta&#44; lo que ha facilitado su empleo en diversas especialidades&#44; como la medicina interna o la medicina de familia&#46; La valoraci&#243;n ecogr&#225;fica de la aorta abdominal es sencilla y puede realizarla con fiabilidad cualquier m&#233;dico con un periodo de entrenamiento corto<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">26</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El objetivo de este estudio es doble&#58; a&#41;<span class="elsevierStyleHsp" style=""></span>determinar la prevalencia de AAA en pacientes con riesgo cardiovascular elevado o que ya hab&#237;an sufrido alguna complicaci&#243;n cardiovascular&#44; y b&#41;<span class="elsevierStyleHsp" style=""></span>valorar la relaci&#243;n del tama&#241;o de la aorta con los diferentes factores de riesgo cardiovascular y evaluar las caracter&#237;sticas espec&#237;ficas de estos pacientes&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes y m&#233;todos</span><p id="par0035" class="elsevierStylePara elsevierViewall">Estudio observacional&#44; transversal y multic&#233;ntrico en el que participaron seis unidades de medicina interna que dispon&#237;an de equipo de ecograf&#237;a y experiencia en su manejo&#46; El reclutamiento de pacientes se prolong&#243; durante 24<span class="elsevierStyleHsp" style=""></span>meses&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Para ello se incluyeron de forma no consecutiva varones mayores de 55<span class="elsevierStyleHsp" style=""></span>a&#241;os y mujeres mayores de 65<span class="elsevierStyleHsp" style=""></span>a&#241;os con riesgo cardiovascular alto o muy alto&#44; siguiendo los criterios de las gu&#237;as europeas sobre prevenci&#243;n de la enfermedad cardiovascular<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">27</span></a>&#44; que fueron identificados y reclutados de modo oportunista en los diferentes &#225;mbitos asistenciales de la medicina interna &#40;urgencia hospitalaria&#44; consulta externa y hospitalizaci&#243;n&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">La diabetes mellitus se defini&#243; como glucemia &#62;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl en cualquier momento del d&#237;a acompa&#241;ada de s&#237;ntomas de diabetes&#44; glucemia en ayunas &#8805;<span class="elsevierStyleHsp" style=""></span>126<span class="elsevierStyleHsp" style=""></span>mg&#47;dl en al menos dos determinaciones repetidas&#44; glucemia &#8805;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl a las 2<span class="elsevierStyleHsp" style=""></span>h de una sobrecarga oral de glucosa o hemoglobina glucosilada &#40;HbA1c&#41; &#8805;<span class="elsevierStyleHsp" style=""></span>6&#44;5&#37;&#46; La enfermedad renal cr&#243;nica moderada se defini&#243; como la presencia de un filtrado glomerular &#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> empleando la f&#243;rmula MDRD&#46; La presencia de microalbuminuria y proteinuria se analiz&#243; mediante el cociente alb&#250;mina&#47;creatinina en muestra &#250;nica de orina&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Los factores de riesgo cardiovascular que se registraron fueron los siguientes&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0055" class="elsevierStylePara elsevierViewall">HTA o existencia de tratamiento antihipertensivo&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Presi&#243;n de pulso elevada &#40;diferencia entre presi&#243;n sist&#243;lica y diast&#243;lica &#62;<span class="elsevierStyleHsp" style=""></span>62<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Tabaquismo &#40;fumadores activos y exfumadores&#59; cuantificaci&#243;n por paquetes&#47;a&#241;o&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Dislipemia &#40;colesterol total &#62;<span class="elsevierStyleHsp" style=""></span>190<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; colesterol LDL &#62;<span class="elsevierStyleHsp" style=""></span>115<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; colesterol HDL &#60;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; triglic&#233;ridos &#62;<span class="elsevierStyleHsp" style=""></span>150<span class="elsevierStyleHsp" style=""></span>mg&#47;dl o tratamiento hipolipemiante&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Diabetes mellitus&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Obesidad troncular&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8226;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Antecedentes familiares de enfermedad cardiovascular prematura &#40;&#60;<span class="elsevierStyleHsp" style=""></span>55<span class="elsevierStyleHsp" style=""></span>a&#241;os en varones y &#60;<span class="elsevierStyleHsp" style=""></span>65<span class="elsevierStyleHsp" style=""></span>a&#241;os en mujeres&#41;&#46;</p></li></ul></p><p id="par0090" class="elsevierStylePara elsevierViewall">El per&#237;metro de la cintura se midi&#243; con una cinta m&#233;trica inextensible en el punto medio entre el reborde costal inferior y la cresta il&#237;aca&#44; y el de la cadera a nivel de los troc&#225;nteres mayores&#46; El &#237;ndice cintura-cadera se calcul&#243; con la f&#243;rmula&#58; circunferencia de la cintura &#40;cm&#41;&#47;circunferencia de la cadera &#40;cm&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Para la medici&#243;n del di&#225;metro de la aorta abdominal se utiliz&#243; una sonda convex de baja frecuencia &#40;&#60;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>MHz&#41;&#44; explor&#225;ndose al enfermo en dec&#250;bito supino&#46; Se realizaron cortes transversales de la aorta desde la salida de las arterias renales hasta la bifurcaci&#243;n de las arterias il&#237;acas&#44; seleccion&#225;ndose los di&#225;metros anteroposterior y transversal m&#225;ximos detectados a lo largo de todo el recorrido de la aorta abdominal&#46; Se defini&#243; el AAA como la presencia de un di&#225;metro de la aorta abdominal infrarrenal &#8805;<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Se incluyeron como variables independientes la informaci&#243;n demogr&#225;fica&#44; los antecedentes personales y los signos exploratorios necesarios para establecer el riesgo vascular &#40;definidos previamente&#41;&#46; La variable dependiente fue el di&#225;metro m&#225;ximo de la aorta abdominal&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Para facilitar la inclusi&#243;n de las variables se dise&#241;&#243; un formulario en una p&#225;gina web espec&#237;fica para el estudio&#44; a la que tuvieron acceso individualizado todos los investigadores&#46; En el registro informatizado no se incluy&#243; ninguna variable que pudiera identificar al paciente&#44; cumpliendo los criterios de seguridad exigidos por la Ley Org&#225;nica de Protecci&#243;n de Datos&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Los criterios de exclusi&#243;n fueron los siguientes&#58; pacientes que no quisieron participar en el estudio y&#47;o no firmaron el consentimiento informado&#44; diagn&#243;stico de AAA previo al inicio del estudio&#44; imposibilidad para medir el di&#225;metro de la aorta abdominal&#44; pacientes diagnosticados de demencia moderada-severa o que presentaran alteraci&#243;n o trastorno del nivel de consciencia que les impidiera la firma voluntaria del consentimiento informado&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">En cuanto al an&#225;lisis estad&#237;stico&#44; las variables cuantitativas se expresaron mediante la media aritm&#233;tica y la desviaci&#243;n est&#225;ndar &#40;mediana y rango intercuartil para variables no param&#233;tricas&#41;&#44; y las variables cualitativas por su porcentaje&#46; Para el an&#225;lisis univariante se utiliz&#243; el test t de Student &#40;test de Mann&#8211;Whitney para variables no param&#233;tricas&#41; para comparar medias y la prueba de chi-cuadrado &#40;&#967;<span class="elsevierStyleSup">2</span>&#41; para comparar proporciones&#46; En el an&#225;lisis multivariante se utiliz&#243; la regresi&#243;n log&#237;stica binaria&#44; incluy&#233;ndose las variables cl&#237;nicamente significativas&#46; El estudio estad&#237;stico fue realizado mediante el programa SPSS versi&#243;n 22 &#40;SPSS&#44; Inc&#46;&#44; Chicago&#44; IL&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">El estudio fue aprobado en las diferentes comisiones de investigaci&#243;n de cada centro hospitalario y en el Comit&#233; de Ensayos Cl&#237;nicos del Hospital Universitario de Getafe&#46; Todos los pacientes incluidos firmaron el consentimiento informado&#46; Ninguna de las actuaciones realizadas en el estudio demor&#243; el diagn&#243;stico o el tratamiento de los pacientes&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0125" class="elsevierStylePara elsevierViewall">Se reclutaron un total de 688 pacientes&#44; de los que 659 &#40;95&#44;7&#37;&#41; fueron finalmente incluidos&#44; con una edad media de 71 &#40;&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;7&#41; a&#241;os&#46; Se detect&#243; la presencia de un AAA en 53 pacientes &#40;8&#37;&#41;&#44; la mayor&#237;a varones &#40;94&#44;3&#37;&#41;&#46; Las caracter&#237;sticas demogr&#225;ficas de los diferentes grupos se detallan en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; En la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> se presenta un histograma de frecuencias del di&#225;metro m&#225;ximo de la aorta abdominal en el total de pacientes incluidos en el estudio&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">El an&#225;lisis multivariante se llev&#243; a cabo mediante una regresi&#243;n log&#237;stica binaria en la que se incluyeron seis variables&#59; en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se puede observar la estimaci&#243;n de riesgo de cada una de ellas&#46; Cuatro variables demostraron su asociaci&#243;n independiente con el desarrollo de AAA&#58; edad&#44; sexo&#44; tabaquismo activo y arteriopat&#237;a perif&#233;rica&#44; siendo la diabetes mellitus un factor protector&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">Por otra parte&#44; se detectaron un total de 342 pacientes &#40;49&#44;7&#37; del total&#41; con dilataci&#243;n subaneurism&#225;tica de la aorta&#44; de los cuales 292 ten&#237;an di&#225;metros comprendidos entre 20 y 24&#44;9<span class="elsevierStyleHsp" style=""></span>mm y los 50 restantes entre 25 y 29&#44;9<span class="elsevierStyleHsp" style=""></span>mm&#46; Como puede observarse en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#44; los pacientes eran predominantemente varones&#44; m&#225;s del 65&#37; ten&#237;an antecedente de tabaquismo&#44; la mayor&#237;a ten&#237;an hipertensi&#243;n arterial y dislipemia y casi tres cuartas partes presentaban tres o m&#225;s factores de riesgo simult&#225;neos&#46; La diabetes mellitus estaba presente en m&#225;s del 60&#37; de los pacientes&#44; y los antecedentes familiares de enfermedad vascular prematura eran casi testimoniales&#46; Este perfil es similar al de los pacientes con AAA establecido&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0145" class="elsevierStylePara elsevierViewall">Los primeros estudios realizados en pa&#237;ses desarrollados mostraron una prevalencia de AAA en varones mayores de 65<span class="elsevierStyleHsp" style=""></span>a&#241;os de entre el 4 y el 7&#37;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">28&#44;29</span></a>&#46; En estudios poblacionales m&#225;s recientes &#40;incluyendo registros espa&#241;oles&#41; la prevalencia ha descendido hasta el 1-2&#37;&#44; probablemente por un mejor control de los factores de riesgo cardiovascular y la reducci&#243;n del tabaquismo en nuestro entorno<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">La prevalencia de AAA en la muestra de nuestro estudio &#40;8&#37;&#41; es superior a la registrada en trabajos similares<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">31</span></a>&#44; y probablemente se deba a que nuestra poblaci&#243;n presentaba una edad media m&#225;s elevada y una mayor prevalencia de tabaquismo y enfermedad cardiovascular establecida&#44; factores asociados a una mayor prevalencia de AAA&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Los AAA se asocian con la edad&#44; el sexo masculino&#44; el tabaquismo&#44; la hipertensi&#243;n&#44; la historia familiar de AAA y la presencia de enfermedad cardiovascular previa&#44; en especial la cardiopat&#237;a isqu&#233;mica<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">32</span></a>&#46; En nuestro estudio&#44; la edad y el sexo masculino fueron las variables demogr&#225;ficas asociadas a un mayor riesgo de la enfermedad&#59; a partir de los 67-68<span class="elsevierStyleHsp" style=""></span>a&#241;os se detectan el 75-80&#37; de los AAA&#46; La diabetes mellitus&#44; al igual que en otras publicaciones&#44; se erigi&#243; como un factor protector para el desarrollo de AAA&#59; se ha planteado la posibilidad de que la glucosilaci&#243;n de las mol&#233;culas de la matriz extracelular y el consiguiente aumento de su resistencia a la prote&#243;lisis pueda desempe&#241;ar un papel clave en esta relaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">33</span></a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Dentro de los factores de riesgo cardiovascular y lesi&#243;n de &#243;rganos diana&#44; solo el consumo de tabaco y la arteriopat&#237;a perif&#233;rica mostraron una asociaci&#243;n independiente con la presencia de AAA&#59; es probable que el motivo sea la falta de potencia estad&#237;stica del modelo en relaci&#243;n con el tama&#241;o muestral&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Aunque no era uno de los objetivos de este estudio y&#44; por tanto&#44; no se ha profundizado en ello&#44; se han analizado las caracter&#237;sticas de los pacientes con dilataci&#243;n subaneurism&#225;tica de la aorta &#40;di&#225;metro a&#243;rtico entre 25-29&#44;9<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; advirti&#233;ndose que los factores de riesgo presentes en ellos son muy similares a los de los pacientes con AAA establecido&#46; La historia natural de esas aortas &#171;anormales&#187; indica que m&#225;s de un 50&#37; progresan a AAA en 5<span class="elsevierStyleHsp" style=""></span>a&#241;os<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">34</span></a>&#46; Aunque actualmente no pueden efectuarse recomendaciones firmes para el cribado peri&#243;dico a esta poblaci&#243;n&#44; en algunos programas se incluye la realizaci&#243;n de una nueva ecograf&#237;a a los 5<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; una estrategia que est&#225; siendo revisada por el <span class="elsevierStyleItalic">National Health Service Abdominal Aortic Aneurysm Screening Programme</span> &#40;NAAASP&#41;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">35</span></a>&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Un aspecto relevante sobre el que nos gustar&#237;a hacer &#233;nfasis es la utilidad de la ecograf&#237;a abdominal realizada por generalistas en la detecci&#243;n del AAA en el subgrupo de pacientes en los que el riesgo vascular es m&#225;s elevado&#46; Dado que se trata de una prueba relativamente sencilla e inocua y que no requiere un periodo de formaci&#243;n largo&#44; puede llevarse a cabo a pie de cama durante la hospitalizaci&#243;n o en la consulta externa en pacientes ambulatorios&#46; Tal y como se desprende del trabajo de Sis&#243;-Almirall et al&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">36</span></a> acerca de la ecograf&#237;a en atenci&#243;n primaria para la detecci&#243;n del AAA&#44; es posible que en un futuro no muy lejano el cribado de esta patolog&#237;a pueda llevarse a cabo en los centros de salud por parte de los m&#233;dicos de familia&#44; remitiendo al paciente&#44; en caso de indicaci&#243;n quir&#250;rgica&#44; a la consulta de angiolog&#237;a y cirug&#237;a vascular&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">El estudio tiene sus limitaciones&#44; como las variaciones dependientes del observador cuando realiza la ecograf&#237;a&#44; a pesar de que el procedimiento no presenta grandes dificultades en su interpretaci&#243;n&#46; Adicionalmente&#44; el m&#233;todo de medida no se encuentra estandarizado en los diferentes programas de cribado<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a>&#46; Por otro lado&#44; la diversa procedencia que presenta la poblaci&#243;n&#44; concentrada en nivel de riesgo vascular identificado de modo oportunista&#44; hace dif&#237;cil la comparaci&#243;n con otros &#225;mbitos asistenciales bien definidos&#46; Al tratarse de una poblaci&#243;n seleccionada de alto o muy alto riesgo vascular&#44; los resultados no son extrapolables al resto de la poblaci&#243;n&#46; Finalmente&#44; es necesario dise&#241;ar estudios dirigidos a la detecci&#243;n de pacientes con dilataciones subaneurism&#225;ticas de la aorta que confirmen los resultados obtenidos en esta subpoblaci&#243;n y la necesidad de cribado&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">En definitiva&#44; en ausencia de una pol&#237;tica sistem&#225;tica de cribado en nuestro medio&#44; los hallazgos de este trabajo reivindican la importancia de una aproximaci&#243;n oportunista del cribado de AAA en pacientes de alto y muy alto riesgo cardiovascular&#44; en particular varones mayores de 65<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; fumadores y con historia de enfermedad arterial perif&#233;rica&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicto de intereses</span><p id="par0185" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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            0 => "Aneurisma de aorta abdominal"
            1 => "Dilataci&#243;n a&#243;rtica subaneurism&#225;tica"
            2 => "Ecograf&#237;a"
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            0 => "Abdominal aortic aneurysm"
            1 => "Subaneurysmal aortic dilatation"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Determinar la prevalencia de aneurisma de aorta abdominal &#40;AAA&#41;&#44; definido por un di&#225;metro arterial &#8805;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>mm&#44; en pacientes con alto o muy alto riesgo cardiovascular &#40;RCV&#41; y evaluar sus caracter&#237;sticas cl&#237;nicas&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Pacientes y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional&#44; transversal y multic&#233;ntrico realizado en servicios de Medicina Interna del pa&#237;s a varones con edad &#62;<span class="elsevierStyleHsp" style=""></span>55<span class="elsevierStyleHsp" style=""></span>a&#241;os y mujeres &#62;<span class="elsevierStyleHsp" style=""></span>65<span class="elsevierStyleHsp" style=""></span>a&#241;os que ten&#237;an un RCV alto o muy alto reclutados durante 24<span class="elsevierStyleHsp" style=""></span>meses&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 659 pacientes&#46; La prevalencia de AAA fue del 8&#37; &#40;53 pacientes&#41;&#46; El 76&#44;9&#37; fueron varones&#44; con edad media de 71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;7<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46; El an&#225;lisis multivariante demostr&#243; asociaci&#243;n entre AAA y la edad &#40;OR&#58; 1&#44;06&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;02-1&#44;1&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; el sexo masculino &#40;OR&#58; 5&#44;6&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;6-18&#44;8&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; el tabaquismo activo &#40;OR&#58; 3&#44;22&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;16-8&#44;93&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;024&#41; y la arteriopat&#237;a perif&#233;rica &#40;OR&#58; 3&#44;51&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;73-7&#44;09&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; siendo la diabetes mellitus un factor protector independiente &#40;OR&#58; 0&#44;41&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;22-0&#44;78&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;06&#41;&#46; Los pacientes con dilataci&#243;n subaneurism&#225;tica de la aorta &#40;di&#225;metro de la aorta abdominal 25-29&#44;9<span class="elsevierStyleHsp" style=""></span>mm&#41; presentaban similares caracter&#237;sticas que los pacientes con AAA&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La prevalencia de AAA en pacientes de alto RCV es elevada&#46; El cribado ecogr&#225;fico puede ser realizado por m&#233;dicos generalistas&#46; Pueden beneficiarse de un cribado oportunista los varones de m&#225;s de 65<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; con RCV elevado&#44; especialmente si presentan tabaquismo activo o arteriopat&#237;a perif&#233;rica&#46;</p></span>"
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            "titulo" => "Pacientes y m&#233;todos"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To determine the prevalence of abdominal aortic aneurysm &#40;AAA&#41; &#40;arterial diameter &#8805;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; in patients with high or very high cardiovascular risk &#40;CVR&#41; and to evaluate their clinical features&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Observational&#44; cross-sectional and multicentric study conducted in Spanish Internal Medicine Services&#46; We enrolled men with age &#62;<span class="elsevierStyleHsp" style=""></span>55<span class="elsevierStyleHsp" style=""></span>years and women &#62;<span class="elsevierStyleHsp" style=""></span>65<span class="elsevierStyleHsp" style=""></span>years who had a high or very high CVR&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The study included 659 patients&#46; The prevalence of AAA was 8&#37; &#40;53 patients&#41;&#46; 76&#46;9&#37; were male with a mean age of 71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;7<span class="elsevierStyleHsp" style=""></span>years&#46; The multivariate analysis showed an association between AAA and age &#40;OR&#58; 1&#46;06&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 1&#46;02-1&#46;1&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#44; male sex &#40;OR&#58; 5&#46;6&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 1&#46;6-18&#46;8&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#44; active smoking &#40;OR&#58; 3&#46;22&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 1&#46;16-8&#46;93&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;024&#41; and peripheral arterial disease &#40;OR&#58; 3&#46;51&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 1&#46;73-7&#46;09&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46; Diabetes mellitus was an independent protective factor &#40;OR&#58; 0&#46;41&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 0&#46;22-0&#46;78&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;06&#41;&#46; Those with subaneurysmal dilatation of the abdominal aorta &#40;diameter 25-29&#46;9<span class="elsevierStyleHsp" style=""></span>mm&#41; presented similar features as patients with AAA&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The prevalence of AAA in patients with high CVR is high&#46; Ultrasound screening can be performed by general practitioners&#46; Men &#62;<span class="elsevierStyleHsp" style=""></span>65<span class="elsevierStyleHsp" style=""></span>years with elevated CVR could benefit&#44; particularly in the presence of active smoking or peripheral arterial disease&#46;</p></span>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">AA&#58; aorta abdominal&#59; AAA&#58; aneurisma de aorta abdominal&#59; AF&#58; antecedentes familiares&#59; AP&#58; anteroposterior&#59; DM&#58; diabetes mellitus&#59; EVP&#58; enfermedad vascular prematura&#59; FA&#58; fibrilaci&#243;n auricular&#59; FG&#58; Filtrado glomerular estimado&#59; FR&#58; factores de riesgo&#59; HTA&#58; hipertensi&#243;n arterial&#59; IMC&#58; &#237;ndice de masa corporal&#59; T&#58; transversal&#46;</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">&#42; Mediana &#40;rango intercuartil&#41;&#46;</p>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">606&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mujeres&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;5&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">149 &#40;24&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Tabaquismo &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">428 &#40;64&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44 &#40;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">384 &#40;63&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Exfumadores</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">325 &#40;49&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29 &#40;54&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">296 &#40;48&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Fumadores activos</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">103 &#40;15&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;28&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88 &#40;14&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Exposici&#243;n acumulada &#40;n&#250;mero de paquetes-a&#241;o&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&#44;3 &#177; 32&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&#44;9 &#177; 30&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&#44;6 &#177; 31&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Consumo de alcohol &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">182 &#40;27&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;28&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">167 &#40;27&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0913&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">HTA &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">596 &#40;90&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 &#40;94&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">546 &#40;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;464&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">DM &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">354 &#40;53&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 &#40;33&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">333 &#40;54&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Dislipemia &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">621 &#40;94&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 &#40;94&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">571 &#40;94&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;750&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">FA &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91 &#40;13&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;13&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">84 &#40;13&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;545&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Enfermedad cerebrovascular &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">122 &#40;18&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;16&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">113 &#40;18&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;765&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Cardiopat&#237;a isqu&#233;mica &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">233 &#40;35&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;45&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">208 &#40;34&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;115&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Arteriopat&#237;a perif&#233;rica &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74 &#40;11&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;30&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37 &#40;6&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">FG estimado &#40;ml&#47;min&#47;1&#44;73 m</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77&#44;5 &#177; 27&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73&#44;1 &#177; 25&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77&#44;9 &#177; 27&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;218&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Estadios funci&#243;n renal</span></td><td class="td" title="table-entry  " align="left" valign="top">0&#44;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>FG &#62; 60 ml&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">494 &#40;75&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37 &#40;69&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">457 &#40;75&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>FG 59-30 ml&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">138 &#40;20&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;24&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">125 &#40;20&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>FG &#60; 30 ml&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;4&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;5&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;4&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Retinopat&#237;a avanzada &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;3&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;3&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;459&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">&#8805; 3 FR simult&#225;neos &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">534 &#40;73&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40 &#40;75&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">447 &#40;73&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;786&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">IMC</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#44;9 &#177; 4&#44;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#44;3 &#177; 5&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#177; 4&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;348&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">&#205;ndice cintura-cadera</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#177; 0&#44;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;01 &#177; 0&#44;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;99 &#177; 0&#44;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;467&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">&#193;cido &#250;rico &#40;mg&#47;dl&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#177; 1&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;9 &#177; 1&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#177; 1&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;620&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Cociente alb&#250;mina&#47;creatinina &#40;mg&#47;g&#41;</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">&#42;</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;3&#8211;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;5&#8211;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;3&#8211;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;281&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Presencia de microalbuminuria &#40;&#62;30 mg&#47;g creatinina&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">155 &#40;23&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;26&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">141 &#40;23&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Di&#225;metro AP m&#225;ximo AA &#40;m&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;9&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45 &#40;74&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;L&#46; Chaikof"
                            1 => "R&#46;L&#46; Dalman"
                            2 => "M&#46;K&#46; Eskandari"
                            3 => "B&#46;M&#46; Jackson"
                            4 => "W&#46;A&#46; Lee"
                            5 => "M&#46;A&#46; Mansour"
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                    0 => array:2 [
                      "doi" => "10.1016/j.jvs.2017.10.044"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Vasc Surg&#46;"
                        "fecha" => "2018"
                        "volumen" => "67"
                        "paginaInicial" => "2"
                        "paginaFinal" => "77"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29268916"
                            "web" => "Medline"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Abdominal aortic aneurysm"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "K&#46; Craig Kent"
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                        ]
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                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1056/NEJMcp1401430"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med&#46;"
                        "fecha" => "2014"
                        "volumen" => "371"
                        "paginaInicial" => "2101"
                        "paginaFinal" => "2108"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25427112"
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Vol. 218. Núm. 9.
Páginas 461-467 (diciembre 2018)
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Vol. 218. Núm. 9.
Páginas 461-467 (diciembre 2018)
Original
Prevalencia de aneurisma de aorta abdominal en pacientes con alto riesgo cardiovascular
Prevalence of abdominal aortic aneurysm in patients with high cardiovascular risk
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183
M.A. Cornejo Saucedoa, D. García-Gila,
Autor para correspondencia
urgenciashupr@gmail.com

Autor para correspondencia.
, F.M. Brun Romeroa, A. Torres do Regob, L. Beltrán Romeroc, E. Rodilla Salad, G. Acosta Guerrae, J. Villanueva Martínezf, J.M. Casas Rojof, J. Torres Machof, G. García de Casasola-Sánchezf, en representación de la Sociedad Española de Medicina Interna y del Grupo de Trabajo de Ecografía Clínica
a Unidad de Gestión Clínica Medicina Interna y Urgencias, Hospital San Carlos, San Fernando, Cádiz, España
b Servicio de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España
c Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, España
d Servicio de Medicina Interna, Hospital de Sagunto, Sagunto, Valencia, España
e Centro de Salud Las Remudas, Las Remudas, Las Palmas, España
f Servicio de Medicina Interna, Hospital Universitario Infanta Cristina, Parla, Madrid, España
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Tabla 1. Variables demográficas, cualitativas y cuantitativas
Tabla 2. Análisis multivariante de los factores de riesgo de aneurisma de aorta abdominal
Tabla 3. Características de los pacientes con dilatación subaneurismática de la aorta
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Resumen
Objetivo

Determinar la prevalencia de aneurisma de aorta abdominal (AAA), definido por un diámetro arterial ≥30mm, en pacientes con alto o muy alto riesgo cardiovascular (RCV) y evaluar sus características clínicas.

Pacientes y métodos

Estudio observacional, transversal y multicéntrico realizado en servicios de Medicina Interna del país a varones con edad >55años y mujeres >65años que tenían un RCV alto o muy alto reclutados durante 24meses.

Resultados

Se incluyeron 659 pacientes. La prevalencia de AAA fue del 8% (53 pacientes). El 76,9% fueron varones, con edad media de 71±8,7años. El análisis multivariante demostró asociación entre AAA y la edad (OR: 1,06; IC95%: 1,02-1,1; p<0,01), el sexo masculino (OR: 5,6; IC95%: 1,6-18,8; p=0,01), el tabaquismo activo (OR: 3,22; IC95%: 1,16-8,93; p=0,024) y la arteriopatía periférica (OR: 3,51; IC95%: 1,73-7,09; p<0,01), siendo la diabetes mellitus un factor protector independiente (OR: 0,41; IC95%: 0,22-0,78; p=0,06). Los pacientes con dilatación subaneurismática de la aorta (diámetro de la aorta abdominal 25-29,9mm) presentaban similares características que los pacientes con AAA.

Conclusiones

La prevalencia de AAA en pacientes de alto RCV es elevada. El cribado ecográfico puede ser realizado por médicos generalistas. Pueden beneficiarse de un cribado oportunista los varones de más de 65años, con RCV elevado, especialmente si presentan tabaquismo activo o arteriopatía periférica.

Palabras clave:
Aneurisma de aorta abdominal
Dilatación aórtica subaneurismática
Ecografía
Cribado oportunista
Factores de riesgo vascular
Abstract
Background

To determine the prevalence of abdominal aortic aneurysm (AAA) (arterial diameter ≥30mm), in patients with high or very high cardiovascular risk (CVR) and to evaluate their clinical features.

Patients and methods

Observational, cross-sectional and multicentric study conducted in Spanish Internal Medicine Services. We enrolled men with age >55years and women >65years who had a high or very high CVR.

Results

The study included 659 patients. The prevalence of AAA was 8% (53 patients). 76.9% were male with a mean age of 71±8.7years. The multivariate analysis showed an association between AAA and age (OR: 1.06; 95%CI: 1.02-1.1; P<.01), male sex (OR: 5.6; 95%CI: 1.6-18.8; P=.01), active smoking (OR: 3.22; 95%CI: 1.16-8.93; P=.024) and peripheral arterial disease (OR: 3.51; 95%CI: 1.73-7.09; P<.01). Diabetes mellitus was an independent protective factor (OR: 0.41; 95%CI: 0.22-0.78; P=.06). Those with subaneurysmal dilatation of the abdominal aorta (diameter 25-29.9mm) presented similar features as patients with AAA.

Conclusions

The prevalence of AAA in patients with high CVR is high. Ultrasound screening can be performed by general practitioners. Men >65years with elevated CVR could benefit, particularly in the presence of active smoking or peripheral arterial disease.

Keywords:
Abdominal aortic aneurysm
Subaneurysmal aortic dilatation
Ultrasound
Opportunistic screening
Cardiovascular risk factors

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