Abdominal aortic aneurysm risk factors: who is at risk and who gets screened

What an abdominal aortic aneurysm is

Aortic aneurysms are balloon-like bulges in the aorta, the main artery carrying oxygen-rich blood to your body. The abdominal part of the aorta is the most common place for an aneurysm (NHLBI). The USPSTF usually defines an AAA as a width of 3.0 cm or more (USPSTF 2019).

Aortic aneurysms can develop and grow before causing any symptoms. If one grows large, it can burst (rupture) or tear the wall of the artery (dissection), and both can be life-threatening (NHLBI). Up to 81% of people die when an AAA bursts (USPSTF 2019).

Risk factors that raise the risk

• Smoking. Cigarette smoking is one of the main factors that raises the risk of an aortic aneurysm, especially an abdominal one. In current smokers, an AAA may grow more quickly and be more likely to burst (NHLBI). The USPSTF calls smoking the strongest predictor of who gets an AAA, how fast it grows and whether it bursts, and the more someone has smoked, the higher the risk (USPSTF 2019).
• Age. The risk goes up as you age, and AAAs are most common in adults after age 65 (NHLBI).
• Being male. Men are more likely than women to develop aortic aneurysms. But an existing aneurysm is more likely to rupture at a smaller size in women than in men (NHLBI).
• Family history. One in 10 people with an AAA have a family history of them, and the chance of developing one is 1 in 5 for people who have a parent, brother, sister or child with the condition (NHLBI). The USPSTF says a close relative with an AAA doubles the risk (USPSTF 2019).
• Atherosclerosis and other artery disease. Atherosclerosis, coronary heart disease and peripheral artery disease are risk factors, as are aneurysms in other blood vessels (NHLBI).
• High blood pressure. It is the leading risk factor for aneurysms in the chest and also a risk factor for AAA (NHLBI).
• Unhealthy cholesterol levels (NHLBI) (MedlinePlus).
• Other conditions. COPD, kidney conditions such as chronic kidney disease or polycystic kidney disease, obesity, vasculitis and pheochromocytoma (a rare adrenal tumor that can raise blood pressure) (NHLBI).
• Stimulants. Drugs such as cocaine raise blood pressure and the risk of an aortic aneurysm (NHLBI).

Race and ethnicity

NHLBI says AAAs are less common in Hispanic, African American and Asian American people (NHLBI), and MedlinePlus lists being white as a higher risk for AAA (MedlinePlus).

Which ones you can change

You may not be able to prevent an aortic aneurysm, but MedlinePlus says you can lower your risk by not smoking or quitting, managing your blood pressure and cholesterol, eating a heart-healthy diet, getting regular physical activity, managing stress, and knowing your family history and asking your provider about screening (MedlinePlus). NHLBI also advises avoiding stimulants such as cocaine (NHLBI).

Signs of a rupture: call 911

A ruptured aortic aneurysm can cause sudden, severe internal bleeding and is a medical emergency. MedlinePlus says to call 911 right away if you have (MedlinePlus):

• Sudden, severe pain in your belly, chest or back
• Dizziness
• A fast heartbeat

Before a rupture, most aortic aneurysms cause no symptoms. When they do, signs can include a pulsing or throbbing feeling in the belly, and pain in the neck, jaw, back, chest, shoulder or belly (MedlinePlus). NHLBI also lists feeling full after eating very little (NHLBI). Tell your provider about these.

Who gets screened

The screening test is a one-time abdominal ultrasound. It finds 94% to 100% of aneurysms, does not hurt and uses no radiation (USPSTF 2019). The USPSTF advises (USPSTF 2019):

"Ever smoked" means 100 or more cigarettes in your life (USPSTF 2019). The AAA screening check shows which row fits you and whether Medicare covers the scan.

Common questions

Can I have an aneurysm and feel fine?

Yes. Most aortic aneurysms do not cause symptoms (MedlinePlus), which is why screening matters for people at higher risk.

Does quitting smoking help if I already have one?

NHLBI says an AAA may grow more quickly and be more likely to burst in current smokers (NHLBI), so quitting is worth it at any point. Ask your provider how often your aneurysm should be checked.

My father had an AAA. What should I do?

Tell your provider. A parent, brother, sister or child with an AAA raises your own chance (NHLBI), and family history is part of the USPSTF screening advice for women and of the MedlinePlus screening list (USPSTF 2019) (MedlinePlus).