Aortic aneurysms affect roughly 5% of men over age 65 who are screened by ultrasound, making them more common than many people realize. Most cause no symptoms and are discovered incidentally during imaging for something else. In the United States, aortic aneurysms and related complications caused nearly 10,000 deaths in 2019.
Overall Prevalence by Location
The aorta, your body’s largest artery, runs from the heart down through the chest and abdomen. An aneurysm is a weakened, ballooned-out section of that artery wall. These can form anywhere along the aorta, but the two main types are abdominal (in the belly) and thoracic (in the chest).
Abdominal aortic aneurysms are far more common than thoracic ones. Population screening studies consistently find abdominal aneurysms in about 2% to 5% of older men, depending on the age range studied. A screening study of men aged 65 to 74 in Spain found a prevalence of 2.3%, while broader studies of men 65 and older put the figure closer to 5%. Thoracic aortic aneurysms are rarer and harder to detect because standard abdominal ultrasound won’t pick them up.
Who Gets Them: Men vs. Women
Men develop abdominal aortic aneurysms at roughly four times the rate women do. Among men over 50, the prevalence is four to five times higher than in women of the same age. This gap narrows with age, but it never fully closes.
The timeline also differs. Women tend to develop aneurysms 10 to 15 years later than men. In men, prevalence climbs steadily with age and peaks at about 5.9% between ages 80 and 85 before declining. In women, prevalence continues rising and reaches 4.5% after age 90. So while aneurysms are often framed as a male condition, older women are far from immune.
There’s another important wrinkle: when women do develop aneurysms, the risk of rupture is higher at the same size. In one study of patients with aneurysms between 5.0 and 5.9 cm who weren’t surgical candidates, the annual rupture rate was 3.9% in women compared to 1.0% in men.
Smoking Is the Strongest Modifiable Risk Factor
No risk factor is more tightly linked to aortic aneurysms than smoking. Current smokers face a three- to sixfold increase in the risk of aneurysm-related events compared to nonsmokers. To put that in perspective, smoking’s association with aortic aneurysms is 2.5 times stronger than its association with coronary artery disease and 3.5 times stronger than its link to stroke. Among the major smoking-related diseases, only chronic obstructive pulmonary disease (COPD) has a stronger connection to tobacco use.
This is why smoking history is the single most important factor in screening recommendations. Even people who quit years ago carry elevated risk compared to those who never smoked.
Family History and Genetic Risk
About 15% of people diagnosed with an abdominal aortic aneurysm have a first-degree relative (parent, sibling, or child) with the same condition. If a close family member has had an aneurysm, your own risk is meaningfully elevated, even if you’ve never smoked. Current guidelines recommend screening men with a family history starting at age 55, and women with a family history starting at age 65.
Racial Differences in Presentation
Research on thoracic aortic aneurysms shows that Black patients tend to present at a younger age than non-Black patients and are more likely to arrive with a ruptured aneurysm (7.3% vs. 4.4%). Black patients also carry higher rates of coexisting conditions like hypertension, diabetes, and kidney disease. Emergency surgery is more common in Black patients, while non-Black patients are more likely to have elective, planned repairs. These patterns suggest that disparities in screening and access to preventive care play a role in outcomes, not just differences in biology.
How Size Determines Danger
Most small aneurysms never rupture. The risk rises sharply with diameter. For aneurysms under 5.0 cm, the annual rupture rate is low enough that doctors typically recommend monitoring with periodic imaging, usually once a year for aneurysms between 4.0 and 4.9 cm. Once an aneurysm reaches 5.5 cm, surgical repair is generally recommended because the risk of rupture begins to outweigh the risks of the procedure.
Large aneurysms are a different story entirely. An aneurysm over 6 cm carries a 20% to 25% annual risk of rupture. A ruptured aortic aneurysm is a life-threatening emergency with a very high mortality rate, which is why catching and monitoring these early matters so much.
Who Should Be Screened
The U.S. Preventive Services Task Force recommends a one-time abdominal ultrasound screening for men aged 65 to 75 who have ever smoked. This is a painless, noninvasive test that takes only a few minutes. The Society for Vascular Surgery casts a slightly wider net, also recommending screening for men 55 and older with a family history of aneurysm, and for women aged 65 to 75 with a history of tobacco use or women 65 and older with a family history.
Because most aortic aneurysms produce no symptoms until they rupture or grow large enough to press on nearby structures, screening is the primary way they’re caught early. If you fall into one of the recommended groups and haven’t been screened, it’s one of the more straightforward things you can do to rule out a silent but serious condition.