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Biomedical subjects

David B Nelson

Publications and source records attributed to David B Nelson.

At least 19 recordsLinked to original sources
PubMed2006

Randomized trial of an intervention to facilitate recycling for relapsed smokers.

BACKGROUND: Tobacco dependence is a chronic condition requiring repeat treatment and long-term follow-up. However, current evidence regarding best approaches to providing these services is fairly limited. This study assessed the effectiveness of an intervention for increasing repeat tobacco-dependence treatment in a population of relapsed smokers. DESIGN: The study was a multicenter randomized controlled trial. SETTING/PARTICIPANTS: Patients aged 19 and older receiving a prescription for nicotine replacement therapy or bupropion for smoking cessation in 2002 at one of five participating Veterans Affairs (VA) facilities were eligible. INTERVENTION: A total of 1900 eligible veterans were randomized to (1) patient phone call to assess smoking status, quit challenges, and treatment preferences, and computerized progress note to providers communicating this information (intervention); or (2) usual care (control). MAIN OUTCOME MEASURES: Outcomes, assessed in 2003, included the proportion of patients receiving repeat pharmacologic or behavioral smoking-cessation treatment in the 6-month follow-up period (assessed from VA pharmacy and outpatient data), 7-day point prevalence abstinence, and satisfaction (assessed by patient survey). RESULTS: Thirty-four percent of intervention participants versus 22% of controls received treatment for tobacco dependence in the follow-up period (p = 0.0001). Thirty-two percent of intervention participants versus 21% of controls received pharmacologic treatment (p = 0.0001), and 12% of intervention subjects versus 8% of controls received behavioral treatment (p = 0.005). Abstinence rates at follow-up were 25% for intervention subjects and 22% for controls (p = 0.15). Intervention subjects were more likely than controls to report being satisfied with the general smoking-cessation help (87% vs 82%, p = 0.01), as well as the pharmacologic help that they received from the VA (89 vs 84%, p = 0.01). CONCLUSIONS: The intervention significantly increased repeat treatment rates and satisfaction with services but did not have a significant effect on abstinence rates.

Adult↗
PubMed2006

Cost-effectiveness of diagnostic tests for toenail onychomycosis: a repeated-measure, single-blinded, cross-sectional evaluation of 7 diagnostic tests.

OBJECTIVE: Our purpose was to estimate and compare the cost-effectiveness of the most commonly used diagnostic tests for onychomycosis: potassium hydroxide preparation (KOH), interpreted both by a dermatologist (KOH-CLINIC) and a laboratory technician (KOH-LAB); KOH with dimethyl sulfoxide (KOH-DMSO) and with chlorazol black E (KOH-CBE), interpreted by a dermatologist; culture using dermatophyte test medium, culture with Mycobiotic and Inhibitory Mold Agar (Cx); and histopathologic analysis using periodic acid-Schiff stain (PAS). METHODS: This was a repeated-measure, blinded, cross-sectional study conducted at the Minneapolis Veterans Affairs Medical Center. Inclusion criteria included: at least one toenail with 25% or more clinical disease, which was defined as subungual debris with onycholysis and/or onychauxis. Exclusion criteria included other nail dystrophies, use of oral antifungal medication for 2 months or longer within the past year, or topical ciclopirox lacquer within 6 weeks of enrollment. The main outcome measure was the cost-effectiveness (Medicare and non-Medicare costs) of 7 diagnostic tests. Sensitivity (at least 3 positive tests) was the unit of effectiveness. RESULTS: Two hundred four participants were enrolled; their average age was 69.5 years and 95.5% were male. PAS was the most sensitive test (98.8%); it was statistically significantly more sensitive than all other diagnostic tests except KOH-CBE (94.3%). Dermatophye test medium was the least sensitive test (57.3%). KOH-CBE was statistically significantly more cost effective than any other test, with the exception of KOH-CLINIC and KOH-LAB. PAS was the least cost effective. LIMITATIONS: Test specificities were not evaluated. CONCLUSION: KOH-CBE should be the test of choice for practitioners confident in interpreting KOH preparations because of its combination of high sensitivity and cost-effectiveness.

Aged↗
PubMed2006

Long term clinical trials: how much information do participants retain from the informed consent process?

Previous studies report mixed results about how much information study participants actually can read, understand and retain after completing the informed consent process; fewer studies have examined disparities in the retention and recall of information by patient factors, such as age, education, and race. Not retaining or being able to recall information from the informed consent process has potentially important ethical and legal implications and consequences for research quality and integrity, especially when found in populations that commonly are underserved or underrepresented in clinical trials. To determine how much basic knowledge participants finishing a five-year, multi-center, double-blinded randomized, placebo-controlled clinical trial had about the study, participants (n=1,789) were asked at their final follow-up visit three multiple-choice questions: (1) the study's purpose; (2) the name of the medication under investigation; (3) the main side effect of the medication. The associations between knowledge of these fundamental details and participant social and demographic factors were investigated. A majority of participants correctly recalled the study's purpose (64.7%) and medication (79.6%), but few correctly reported the main side effect (31.1%). In spite of relatively high recall for study purpose and medication, disparities by age, education and race exist. Increasing age was significantly associated with higher odds of incorrectly recalling both the study purpose and the name of the study medication. Likewise those with less than a high school education were more likely to incorrectly identify the study's purpose and the name of the study medication. Black and other non-white race or ethnic groups were more than two and a half times as likely to incorrectly identify the study's purpose. These findings suggest that even the most basic information may not be understood or retained by important subgroups of patients enrolled in clinical trials. Implementing effective strategies, such as additional time and effort for consent or repetition of study information, may be necessary in order to assure ethical and valid consent.

Age Factors↗
PubMed2006

Benefits of telephone care over primary care for smoking cessation: a randomized trial.

BACKGROUND: Brief clinician intervention and telephone counseling are both effective aids for smoking cessation. However, the potential benefit of telephone care above and beyond routine clinician intervention has not been examined previously. The objective of this study is to determine if telephone care increases smoking cessation compared with brief clinician intervention as part of routine health care. METHODS: This 2-group, prospective, randomized controlled trial enrolled 837 daily smokers from 5 Veterans Affairs medical centers in the upper Midwest. The telephone care group (n = 417) received behavioral counseling with mailing of smoking cessation medications as clinically indicated. The standard care group (n = 420) received intervention as part of routine health care. The primary outcome was self-reported 6-month duration of abstinence 12 months after enrollment. Secondary outcomes were 7-day point prevalence abstinence at 3 and 12 months, participation in counseling programs, and use of smoking cessation medications. RESULTS: Using intention-to-treat procedures, we found that the rate of 6-month abstinence at the 12-month follow-up was 13.0% in the telephone care group and 4.1% in the standard care group (odds ratio [OR], 3.50; 95% confidence interval [CI], 1.99-6.15). The rate of 7-day point prevalence abstinence at 3 months was 39.6% in the telephone care group and 10.1% in the standard care group (OR, 5.84; 95% CI, 4.02-8.50). Telephone care compared with standard care increased the rates of participation in counseling programs (97.1% vs 24.0%; OR, 96.22; 95% CI, 52.57-176.11) and use of smoking cessation medications (89.6% vs 52.3%; OR, 7.85; 95% CI, 5.34-11.53). CONCLUSION: Telephone care increases the use of behavioral and pharmacologic assistance and leads to higher smoking cessation rates compared with routine health care provider intervention.

Counseling↗
PubMed2006

Promoting repeat tobacco dependence treatment: are relapsed smokers interested?

BACKGROUND: Promotion of repeat tobacco dependence treatment among relapsed smokers interested in "recycling" (repeat quit attempt) may be a promising approach to increase quit rates. OBJECTIVE: To report relapsed smokers' interest in recycling and their treatment preferences. STUDY DESIGN: Descriptive analysis of a population of relapsed smokers who were randomized to receive a recycling intervention strategy to increase tobacco dependence treatment rates, as part of a randomized controlled trial at 5 Veterans Affairs medical centers. METHODS: Individuals prescribed a tobacco dependence medication in 2002 were eligible and were identified from the Department of Veterans Affairs Pharmacy Benefits Management database. Intervention group participants (n = 951) were contacted for a standardized telephone interview approximately 6 months after the prescription fill date to assess smoking status, interest in recycling, and treatment preferences. Bivariate analyses and generalized linear mixed-model regressions were used to describe outcomes. RESULTS: The response rate to the intervention telephone call was 62% (586/951), at which 61% (357/586) of respondents had relapsed. Almost two thirds of relapsed smokers were interested in recycling within 30 days. Of these, 91% wanted behavioral or pharmacologic smoking cessation treatment, and 64% wanted behavioral and pharmacologic treatment. In multivariate analyses, independent predictors of interest in recycling within 30 days included black race, lower smoking level, and greater number of smoking-related medical conditions. CONCLUSION: Most smokers who attempt to quit but relapse want to quit again right away, and most are interested in receiving behavioral and pharmacologic treatment.

Adult↗
PubMed2005

Pulse versus continuous terbinafine for onychomycosis: a randomized, double-blind, controlled trial.

BACKGROUND: Effective treatments for onychomycosis are expensive. Previous studies suggest that less costly, pulsed doses of antifungal medications may be as effective as standard, continuous doses. Terbinafine is the current treatment of choice for toenail onychomycosis. OBJECTIVE: Our purpose was to determine whether pulse-dose terbinafine is as effective as standard continuous-dose terbinafine for treatment of toenail onychomycosis. METHODS: We conducted a double-blind, randomized, noninferiority, clinical intervention trial in the Minneapolis Veterans Affairs Medical Center. The main inclusion criteria for participants were a positive dermatophyte culture and at least 25% distal subungual clinical involvement. Six hundred eighteen volunteers were screened; 306 were randomized. Terbinafine, 250 mg daily for 3 months (continuous) or terbinafine, 500 mg daily for 1 week per month for 3 months (pulse) was administered. The primary outcome measure was mycological cure of the target toenail at 18 months. Secondary outcome measures included clinical cure and complete (clinical plus mycological) cure of the target toenail and complete cure of all 10 toenails. RESULTS: Results of an intent-to-treat analysis did not meet the prespecified criterion for noninferiority but did demonstrate the superiority of continuous-dose terbinafine for: mycological cure of the target toenail (70.9% [105/148] vs 58.7% [84/143]; P =.03, relative risk [RR] of 1.21 [95% confidence interval (CI), 1.02-1.43]); clinical cure of the target toenail (44.6% [66/148] vs 29.3% [42/143]; P =.007, RR =1.52 [95% CI, 1.11-2.07); complete cure of the target toenail (40.5% [60/148] vs 28.0% [40/143]; P =.02, RR=1.45 [95% CI, 1.04-2.01); and complete cure of all 10 toenails (25.2% [36/143] vs 14.7% [21/143]; P =.03, RR =1.71 [95% CI, 1.05-2.79). Tolerability of the regimens did not differ significantly between the groups (chi2 =1.63; P =.65). LIMITATIONS: The study population primarily consisted of older men with severe onychomycosis. CONCLUSIONS: This study demonstrated the superiority of continuous- over pulse-dose terbinafine. We also found this expensive therapy to be much less effective than previously believed, particularly for achieving complete cure of all 10 toenails.

Aged↗
PubMed2005

Health-related quality of life predicts future health care utilization and mortality in veterans with self-reported physician-diagnosed arthritis: the veterans arthritis quality of life study.

OBJECTIVE: To investigate whether health-related quality of life (HRQOL) measures predict health care utilization and mortality in a cohort of veterans with self-reported physician-diagnosed arthritis. METHODS: A cohort of veterans from the Upper Midwest Veterans Integrated Service Network (VISN) was mailed a self-administered questionnaire that was composed of the SF-36V (modified from SF-36 for use in veterans) and questions regarding demographics, current smoking status, limitation of activities of daily living (ADLs), and preexisting physician-diagnosed medical conditions, including arthritis. Within subjects reporting physician-diagnosed arthritis, we analyzed the associations between the SF-36V component summary scales (physical and mental component summary, PCS and MCS, respectively) and the occurrence of any hospitalization, number of hospitalizations, number of outpatient visits, and mortality, for the year after survey administration, using multivariable regression analyses. RESULTS: Of 34,440 survey responders who answered a question regarding arthritis, 18,464 (58%) subjects reported physician-diagnosed arthritis. Arthritic patients in the lowest tertile of PCS scores had significantly higher odds of any hospitalization (Odds ratio (OR) 1.49, 95% confidence interval (CI) [1.25-1.76]) and mortality (OR 1.69, 95% CI [1.18-2.42]), and a significantly higher number of hospitalizations/year (Rate ratio (RR) 1.09, 95% CI [1.05-1.13]) and outpatient visits/year (RR 1.07, 95% CI [1.03-1.11]). Arthritic patients in the lowest tertile of MCS scores had significantly higher odds of any hospitalization (OR 1.20, 95% CI [1.02-1.41]), mortality (OR 2.14, 95% CI [1.56-2.94]), and a significantly higher number of hospitalizations/year (RR 1.05, 95% CI [1.02-1.09]) and outpatient visits/year (RR 1.07, 95% CI [1.03-1.11]). CONCLUSIONS: HRQOL, as assessed by the SF-36V, predicts future inpatient and outpatient health care utilization and mortality in veterans with self-report of physician-diagnosed arthritis.

Activities of Daily Living↗
PubMed2005

PTSD and Treatment Adherence: the role of health beliefs.

Health beliefs have been shown to influence a myriad of medical treatment decisions. More recently, the impact of health beliefs on treatment decisions for mental illness has become a focus of study. This study examines the health beliefs and treatment behavior of veterans with posttraumatic stress disorder (PTSD). Using standard survey methodology, we assessed beliefs about the cause of PTSD, expected duration and controllability of symptoms, and life consequences of having PTSD. Treatment participation and medication compliance were assessed, as were common treatment correlates, such as patient-provider relationships, dosing frequency, side effect severity, number of prescribed medications, and use of drugs or alcohol to control PTSD symptoms. Explanatory models of PTSD, perceived controllability, and use of benzodiazepines were found to predict psychiatric medication use. Negative life consequences of PTSD were associated with participation in psychotherapy. Assessment of health beliefs may help providers to understand their patients' treatment behavior and to facilitate treatment engagement.

Antipsychotic Agents↗
PubMed2005

Health-related quality of life, functional impairment, and healthcare utilization by veterans: veterans' quality of life study.

OBJECTIVES: To describe the health status of veterans receiving care in a veterans integrated service network (VISN). DESIGN: Cross-sectional survey with prospective follow-up. SETTING: Former Upper Midwest VISN 13 (now a part of VISN 23), a regional Veterans Affairs (VA) network comprising five inpatient facilities and associated outpatient clinics. PARTICIPANTS: All veterans in VISN 13 who had at least one inpatient or outpatient encounter between October 1, 1997, and March 31, 1998. MEASUREMENTS: Health-related quality of life (HRQOL) assessed using subscales and component summaries from the 36-item short form for veterans (SF36-V), functional status assessed according to limitations in activities of daily living (ADLs), healthcare utilization assessed according to outpatient visits and hospitalizations, and death. RESULTS: Of 70,334 eligible veterans, 40,508 responded and reported baseline HRQOL significantly lower than that of the general U.S. population for the physical (35.6, P<.001) and mental (46.4, P<.001) component summary scores (PCS and MCS, respectively) of the SF36-V. Many reported complete inability or some difficulty in completing ADLs such as getting in and out of a chair (35.1%) and walking (45.3%). More than 58% indicated some degree of difficulty with at least one of the ADLs. In multivariate analysis, PCS and MCS were significantly associated with subsequent use of inpatient and outpatient care and with mortality. CONCLUSION: The low quality of life and associated high rates of health services utilization in VA patients imply a need for innovative strategies to improve the HRQOL and functional status of this population.

Aged↗
PubMed2005

Post-traumatic stress disorder claims from the viewpoint of veterans service officers.

OBJECTIVE: To situate veterans' experience of the Department of Veterans Affairs claims process in a broader context, this study explored the beliefs of veterans service officers (VSOs) about the Department of Veterans Affairs disability claims process for post-traumatic stress disorder (PTSD). METHODS: A mail survey of the county and national VSOs working in Minnesota was performed. Questionnaires included a modified version of the Disability Application Appraisal Inventory. RESULTS: Most VSOs believe thatveterans value the Department of Veterans Affairs disability status for PTSD to obtain validation for what they experienced in the military and that veterans have negative reactions to the claims process for PTSD. VSOs' satisfaction with the claims process was associated with beliefs about its fairness. CONCLUSIONS: In general, VSOs' beliefs about the reasons veterans value service connection for PTSD parallel those veterans report. More work is needed to determine how VSOs influence veterans, to determine whether PTSD claimants have special or unique needs as they undergo the claims process, and to explore fairness concerns.

Adult↗
PubMed2004

Information resources used in antimicrobial prescribing.

To describe resources clinicians use when they prescribe antimicrobials, the authors surveyed prescribers by telephone within hours (median 2.9) after they ordered one or more antimicrobials for a patient. Among 157 prescribers, 87 (55%) used one or more external resources to aid in decisions about their order. The other 70 (45%) used only their own knowledge and experience. Fifty-nine (38%) consulted another person. Fifty-four (34%) used a print, computer, or Internet resource. In multivariate analysis, use of an external resource was associated with the clinician being on the medical service (odds ratio [OR] 2.99, 95% confidence interval [CI] 1.41-6.3) or being an intern (OR 13.65, 95% CI 1.44-128). Eighty percent of providers said information about antimicrobial prescribing at the point of electronic order entry would be helpful. It was concluded that decision support at the point of electronic order entry is likely to be used and might improve antimicrobial prescribing.

Anti-Bacterial Agents↗
PubMed2004

Development and psychometric properties of the disability application appraisal inventory.

This article describes the development and psychometric properties of an inventory to assess cognitive appraisal of the Department of Veterans Affairs (VA) disability application process, the Disability Application Appraisal Inventory (DAAI). Participants were 439 veterans seeking disability status for posttraumatic stress disorder through the VA and subgroups from that sample. The 3 DAAI scales assess (a) understanding of the disability application process (Knowledge scale) (b) expectations specific to the process (Negative Expectations scale) and (c) investment in obtaining disability status (Importance scale). The scales are internally consistent and largely uncorrelated. Test-retest correlations are adequate for the Negative Expectations and Importance scales. Evidence of factorial and construct validity is presented.

Adult↗
PubMed2004

The Veterans Short Form 36 questionnaire is predictive of mortality and health-care utilization in a population of veterans with a self-reported diagnosis of asthma or COPD.

STUDY OBJECTIVE: Measures of health-related quality of life (HRQL) correlate with disease stage in persons with COPD. However, as their predictive capacity for mortality or medical utilization is less well defined, we sought to examine the relationship of a general measure of HRQL and outcomes in persons with obstructive lung disease. DESIGN: Prospective cohort study. SETTING: Upper Midwest Veterans Integrated Service Network (VISN)-13. PARTICIPANTS: All veterans in VISN-13 (n = 70,017) were surveyed with the Veterans Short Form 36 (SF-36V). Persons with reported asthma or COPD who completed the SF-36V formed the study cohort (n = 8,354). MEASUREMENTS AND RESULTS: For purposes of analysis, individuals were divided into quartiles of HRQL according to their physical component summary (PCS) and mental component summary (MCS), values derived from the SF-36V. Outcomes of mortality, hospitalization, and outpatient visits were recorded for 12 months after the survey. Outpatient utilization was dichotomized into high vs low use, with high use being defined as the upper quartile of visits in the 12 months prior to survey mailing. The study cohort had a mean age of 65 years and was largely male (95%), both consistent with a veteran population. After correcting for potential confounding factors through multivariable regression, the PCS was independently predictive of death, hospitalization, and high outpatient utilization. When using the first quartile of PCS as the reference population, those in the fourth quartile of PCS had a hazard ratio for death of 5.47 (95% confidence interval [CI], 3.63 to 8.26). Similarly, the odds ratios for hospitalization, high primary care visits, and high specialty medicine visits in the fourth quartile of PCS were 1.82 (95% CI, 1.51 to 2.19), 1.54 (95% CI, 1.26 to 1.87), and 1.46 (95% CI, 1.21 to 1.78), respectively. The MCS, through multivariable regression, was predictive of death but unassociated with subsequent hospitalization or high outpatient utilization. CONCLUSION: HRQL, as assessed by the SF-36V, is an independent predictor of mortality, hospitalization, and outpatient utilization in persons with self-reported obstructive lung disease.

Aged↗
PubMed2004

A randomized trial of concurrent versus delayed smoking intervention for patients in alcohol dependence treatment.

OBJECTIVE: Fear of jeopardizing drinking outcomes has resulted in a reluctance to treat tobacco dependence concurrently with alcohol dependence, in spite of the high prevalence of smoking among patients with alcohol dependence. The objective of this study was to compare the effects of smoking treatment and intensive treatment for alcohol dependence, delivered concurrently, with delayed smoking treatment on smoking and alcohol use. METHOD: For the study, 1,943 patients in intensive treatment for alcohol dependence or abuse were screened for participation. Of these, 499 smokers were enrolled and randomized to concurrent (during alcohol treatment) or delayed (6 months later) smoking intervention. The smoking intervention included individual behavioral counseling and nicotine replacement. The main smoking outcome measure was 7-day point prevalent tobacco abstinence, and the main drinking outcome was 6-month prolonged abstinence from alcohol; both measured 18 months after study enrollment. RESULTS: Participants in the concurrent group were more likely to participate in smoking treatment than those in the delayed group (78.5% vs 64.5%, p = .005), but there was no significant difference in cessation rates at 18 months (12.4% vs 13.7%). Prolonged, 6-month abstinence from alcohol was worse in the concurrent group than in the delayed group at 6, 12 and 18 months (41% vs 56%, p =.001; 33% vs 42%,p = .06; 41% vs 48%, p = .14, respectively), and 30-day prolonged alcohol abstinence was also worse in the concurrent treatment group (51% vs 64%, p = .004; 46% vs 53%, p = .11; 48% vs 60%, p = .01, respectively). CONCLUSIONS: These data show that patients in alcohol treatment are interested in smoking cessation, participate in treatment and demonstrate success; but there was no benefit of concurrent treatment. Drinking outcomes were worse with concurrent tobacco treatment. These findings suggest that smoking cessation intervention should be provided to patients after intensive alcohol treatment; however, the data require confirmation because they are not consistent with the existing literature.

Adult↗
PubMed2003

Effectiveness of lipid-lowering medications in outpatients with coronary heart disease in the Department of Veterans Affairs System.

Lipid therapy aimed at reducing low-density lipoprotein cholesterol has been shown, in several large-scale randomized controlled trials, to reduce coronary heart disease (CHD) morbidity and mortality and all-cause mortality in patients with established CHD. However, lipid therapy's effectiveness in usual clinical settings has not been extensively studied. The purpose of this study was to determine the effect of prescription lipid-lowering medication (LLM) on all-cause mortality in a cohort of patients with known CHD. We conducted a retrospective cohort study using linked administrative and clinical databases. Sixteen thousand four hundred seventy patients with CHD who were outpatients at 1 of 5 Veterans Affairs medical facilities in the upper midwest between 1994 and 1996 were identified and then followed until death or the end of the study (December 31, 2000). Pharmacy databases were used to determine whether patients had been prescribed LLMs. Demographics, co-morbid conditions, cardiac medications, and lipid levels were collected. Time-dependent Cox proportional hazards analyses, adjusted for confounding variables, and the propensity score for LLM use were performed to compare survival between those prescribed and those not prescribed LLM. During an average follow-up of 5.9 years, there were 4,821 recorded deaths in patients not prescribed LLM (51%) and 1,245 deaths in patients prescribed LLM (18%). On average, the treated cohort survived 15 months longer than the untreated group (p<0.0001). The age-adjusted hazards ratio associated with LLM use was 0.59 (95% confidence interval 0.55 to 0.63, p=0.0001). After adjusting for propensity score, age, and previous use of LLM, the hazard ratio associated with prescription of LLM was 0.77 (95% confidence interval 0.70 to 0.85, p<0.0001). This study confirms, in a standard clinical setting, the beneficial effects of LLM on total mortality in patients with established CHD. These data suggest that the benefits of lipid therapy observed in highly controlled randomized trials are attainable in usual clinical settings.

Aged↗
PubMed2003

Smokers' relative risk for aortic aneurysm compared with other smoking-related diseases: a systematic review.

OBJECTIVE: Aortic aneurysm has traditionally been considered a manifestation of atherosclerosis, but recent evidence suggests an independent pathogenesis, possibly similar to that of chronic obstructive pulmonary disease (COPD). Further insight into the pathogenesis of aortic aneurysm might be obtained by comparing its association with smoking with that of other smoking-related diseases. STUDY DESIGN: We conducted a systematic review of studies providing relative risk associated with smoking for both aortic aneurysm and other smoking-related diseases. RESULTS: We identified 10 eligible studies, which included more than 3 million subjects. The events reported in 9 studies were death from target diseases; the tenth study reported new diagnoses. Relative risk for aortic aneurysm-related events in current smokers was generally 3 to 6, compared with 1 to 2 for coronary artery disease or cerebrovascular disease and 5 to 12 for COPD. For each category of smoking in each study, relative risk associated with smoking was substantially greater for aortic aneurysm than for coronary artery disease or cerebrovascular disease. Our pooled estimates indicate that, in men, the association of ever smoking with aortic aneurysm is 2.5 times greater than the association of ever smoking with coronary artery disease (95% confidence interval [CI], 2.2, 2.8) and 3.5 times greater than the association of ever smoking with cerebrovascular disease (95% CI, 2.4, 5.3), but only 0.56 as great as the association of ever smoking with COPD (95% CI, 0.36, 0.86). CONCLUSIONS: The difference in magnitude of these associations with smoking is consistent with a non-atherosclerotic cause for aortic aneurysm and/or a stronger effect of smoking on vascular disease in the peripheral arteries.

Aortic Aneurysm↗