A Meta-Analysis of the Association of Chronic Obstructive Pulmonary Disease with Abdominal Aortic Aneurysm Presence

Background: Several caseecontrol and population-based abdominal aortic aneurysm ( AAA) screening studies have reported inconclusive results of the association of chronic obstructive pulmonary disease ( COPD) with AAA presence. To determine whether COPD is associated with AAA presence, we performed a meta-analysis of contemporary clinical studies. Methods: To identify all contemporary caseecontrol and population-based AAA screening studies evaluating the association of COPD with AAA presence, databases including MEDLINE and EMBASE were searched from January 2000 to May 2015 using Web-based search engines ( PubMed and OVID). An adjusted odds ratio ( OR) and 95% confidence intervals ( CI) for COPD or AAA presence ( using multivariable logistic regression) were abstracted from each individual study. We took an OR for AAA presence to be representative of an OR for COPD presence. Results: Of 159 potentially relevant articles screened initially, there were 7 caseecontrol and 4 population-based AAA screening studies that met eligibility requirements and were included. Pooled analysis of all the 11 studies ( 14 estimates, 155,731 participants), 7 caseecontrol studies ( 4171 participants), and 4 population-based AAA screening studies ( 7 estimates, 151,560 participants) respectively demonstrated a statistically significant 1.78-fold ( OR 1.78, 95% CI 1.38-2.30, P < 0.00001), 3.05-fold ( OR 3.05, 95% CI 1.44-6.49, P = 0.004), and 1.24-fold ( OR 1.24, 95% CI 1.04-1.48, P = 0.02) increased prevalence/incidence of COPD in patients with AAA relative to subjects without AAA ( i.e., a statistically significant 1.78-, 3.05-, and 1.24-fold increased prevalence/incidence of AAA in patients with COPD relative to subjects without COPD) ( P for subgroup differences = 0.02). Conclusion: The present meta-analysis demonstrated 1.8-fold increased prevalence/incidence of COPD in patients with AAA relative to subjects without AAA ( i.e., 1.8-fold increased prevalence/incidence of AAA in patients with COPD relative to subjects without COPD), which suggests that COPD is associated with AAA presence.