Serum triglyceride: a possible risk factor for ruptured abdominal aortic aneurysm

Background We aimed to determine the relationship between ruptured abdominal aortic aneurysm (AAA) and serum concentrations of lipids and apolipoproteins. Methods A cohort of 21 520 men, aged 35-64 years, was recruited from men attending the British United Provident Association (BUPA) clinic in London for a routine medical examination in 1975-1982. Smoking habits, weight, height and blood pressure were recorded at entry. Lipids and apolipoproteins were measured in stored serum samples from the 30 men who subsequently died of ruptured AAA and 150 matched controls. Results Triglyceride was strongly related to risk of ruptured AAA. In univariate analyses the risk in men on the 90th centile of the distribution relative to the risk in men on the 10th (RO10-90) was 12 (95% confidence interval [CI]:3.8-37) for triglyceride, 5.5 (95% CT: 1.8-17) for apolipoprotein B (apoB) (the protein component of low density lipoprotein [LDL]), 0.15 (95% CI: 0.04-0.56) for apo Al (the protein component of high density lipoprotein [HDL]), 3.7 (95% CI : 1.4-9.4) for body mass index and 3.0 (95% CI:1.1-8.5) for systolic blood pressure. Lipoprotein (a) (Lp(a)) was not a significant risk factor (RO10-90 = 1.6, 95% CI:0.6-3.0). Ln multivariate analysis triglyceride retained its strong association. Conclusion Triglyceride appears to be a strong risk factor for ruptured AAA, although further studies are required to clarify this. If this and other associations are cause and effect, then changing the distribution of risk factors in the population (by many people stopping smoking and adapting a lower saturated fat diet and by lowering blood pressure) could achieve an important reduction in mortality from ruptured AAA.