Intended for healthcare professionals


Abdominal aortic aneurysm events in the women’s health initiative: cohort study

BMJ 2008; 337 doi: (Published 15 October 2008) Cite this as: BMJ 2008;337:a1724
  1. Frank A Lederle, professor of medicine1,
  2. Joseph C Larson, statistical research associate2,
  3. Karen L Margolis, senior clinical investigator3,
  4. Matthew A Allison, assistant professor of family and preventive medicine4,
  5. Matthew S Freiberg, assistant professor of medicine and epidemiology5,
  6. Barbara B Cochrane, associate professor of family and child nursing6,
  7. William F Graettinger, professor of medicine7,
  8. J David Curb, professor of geriatric medicine and medicine8
  1. 1VA Medical Center, Minneapolis, MN 55417, USA
  2. 2Women’s Health Initiative Clinical Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle, WA 98109
  3. 3HealthPartners Research Foundation, Minneapolis, MN 55440-1524
  4. 4University of California San Diego, La Jolla, CA 92093-0811
  5. 5University of Pittsburgh, Pittsburgh, PA 15215
  6. 6University of Washington School of Nursing, Seattle, WA 98195-7262
  7. 7University of Nevada School of Medicine, Reno, NV 89557
  8. 8University of Hawaii School of Medicine, Honolulu, HI 96813
  1. Correspondence to: F A Lederle frank.lederle{at}
  • Accepted 20 August 2008


Objective To assess the association between potential risk factors and subsequent clinically important abdominal aortic aneurysm events (repairs and ruptures) in women.

Design Large prospective observational cohort study with mean follow-up of 7.8 years.

Setting 40 clinical centres across the United States.

Participants 161 808 postmenopausal women aged 50-79 enrolled in the women’s health initiative.

Main outcome measures Association of self reported or measured baseline variables with confirmed abdominal aortic aneurysm events assessed with multiple logistic regression.

Results Events occurred in 184 women and were strongly associated with age and smoking. Ever smoking, current smoking, and amount smoked all contributed independent risk. Diabetes showed a negative association (odds ratio 0.29, 95% confidence interval 0.13, 0.68), as did postmenopausal hormone therapy. Positive associations were also seen for height, hypertension, cholesterol lowering treatment, and coronary and peripheral artery disease.

Conclusions Our findings confirm the strong positive associations of clinically important abdominal aortic aneurysm with age and smoking in women and the negative association with diabetes previously reported in men.


  • We thank Joann Manson for suggesting this analysis.

  • The WHI investigators

  • Program Office: Elizabeth Nabel, Jacques Rossouw, Shari Ludlam, Joan McGowan, Leslie Ford, Nancy Geller (National Heart, Lung, and Blood Institute, Bethesda, Maryland).

  • Clinical Coordinating Center: Ross Prentice, Garnet Anderson, Andrea LaCroix, Charles L Kooperberg, Ruth E Patterson, Anne McTiernan (Fred Hutchinson Cancer Research Center, Seattle, WA); Evan Stein (Medical Research Labs, Highland Heights, KY); Steven Cummings (University of California at San Francisco, San Francisco, CA).

  • Clinical Centres: Sylvia Wassertheil-Smoller (Albert Einstein College of Medicine, Bronx, NY); Aleksandar Rajkovic (Baylor College of Medicine, Houston, TX); JoAnn E Manson (Brigham and Women’s Hospital, Harvard Medical School, Boston, MA); Charles B Eaton (Brown University, Providence, RI); Lawrence Phillips (Emory University, Atlanta, GA); Shirley Beresford (Fred Hutchinson Cancer Research Center, Seattle, WA); Lisa Martin (George Washington University Medical Center, Washington, DC); Rowan Chlebowski (Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA); Yvonne Michael (Kaiser Permanente Center for Health Research, Portland, OR); Bette Caan (Kaiser Permanente Division of Research, Oakland, CA); Jane Morley Kotchen (Medical College of Wisconsin, Milwaukee, WI); Barbara V Howard (MedStar Research Institute/Howard University, Washington, DC); Linda Van Horn (Northwestern University, Chicago/Evanston, IL); Henry Black (Rush Medical Center, Chicago, IL); Marcia L Stefanick (Stanford Prevention Research Center, Stanford, CA); Dorothy Lane (State University of New York at Stony Brook, Stony Brook, NY); Rebecca Jackson (Ohio State University, Columbus, OH); Cora E Lewis (University of Alabama at Birmingham, Birmingham, AL); Cynthia A Thomson (University of Arizona, Tucson/Phoenix, AZ); Jean Wactawski-Wende (University at Buffalo, Buffalo, NY); John Robbins (University of California at Davis, Sacramento, CA); F Allan Hubbell (University of California at Irvine, CA); Lauren Nathan (University of California at Los Angeles, Los Angeles, CA); Robert D Langer (University of California at San Diego, LaJolla/Chula Vista, CA); Margery Gass (University of Cincinnati, Cincinnati, OH); Marian Limacher (University of Florida, Gainesville/Jacksonville, FL); J David Curb (University of Hawaii, Honolulu, HI); Robert Wallace (University of Iowa, Iowa City/Davenport, IA); Judith Ockene (University of Massachusetts/Fallon Clinic, Worcester, MA); Norman Lasser (University of Medicine and Dentistry of New Jersey, Newark, NJ); Mary Jo O’Sullivan (University of Miami, Miami, FL); Karen Margolis (University of Minnesota, Minneapolis, MN); Robert Brunner (University of Nevada, Reno, NV); Gerardo Heiss (University of North Carolina, Chapel Hill, NC); Lewis Kuller (University of Pittsburgh, Pittsburgh, PA); Karen C Johnson (University of Tennessee Health Science Center, Memphis, TN); Robert Brzyski (University of Texas Health Science Center, San Antonio, TX); Gloria E Sarto (University of Wisconsin, Madison, WI); Mara Vitolins (Wake Forest University School of Medicine, Winston-Salem, NC); Michael Simon (Wayne State University School of Medicine/Hutzel Hospital, Detroit, MI).

  • Contributors: FAL designed the study, did the principal writing, and is guarantor. JCL extracted the data from the WHI database and conducted the analysis in collaboration with FAL. The other authors participated in the original WHI data collection and reviewed the manuscript, providing revisions.

  • Funding: The WHI program is funded by the National Heart, Lung and Blood Institute, US Department of Health and Human Services (contracts N01WH22110, 24152, 32100-2, 32105-6, 32108-9, 32111-13, 32115, 32118-32119, 32122, 42107-26, 42129-32, and 44221).

  • Competing interests: None declared.

  • Ethical approval: Not required.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

View Full Text