At what age should individuals be screened for abdominal aortic aneurysm (AAA) if they have a history of smoking?

Screening for abdominal aortic aneurysm (AAA) is specifically recommended for men aged 65 years and older who have a history of smoking, as they are at a significantly higher risk of developing this condition. The rationale behind starting screening at age 65 is based on epidemiological evidence, which shows that the prevalence of AAA increases with age, particularly in individuals with a history of smoking.

Smokers, in particular, have an increased risk due to the adverse effects of tobacco on vascular health, contributing to both the formation and expansion of aneurysms. Therefore, initiating screening at age 65 allows for early detection and management of AAA, which is crucial since many aneurysms remain asymptomatic until they are large enough to rupture, leading to severe morbidity and mortality.

In contrast, screening at ages younger than 65, such as 60 or 55, is not recommended because the risk of AAA in these age groups, especially among smokers, is not deemed sufficient to warrant routine screening. Aged 70 and older would also be too late to begin screening, as it could miss earlier detection opportunities when intervention would be more effective. Therefore, the current guidelines strongly support screening starting at age 65 for those with a significant risk factor