Question: Can you please explain what an abdominal aortic aneurysm is? What causes some people to get them?

Answer: An aneurysm is a weak and bulging area in a blood vessel's wall. The pressure of blood can cause the artery wall to stretch over time. So if an aneurysm gets too large, it can burst. Risk factors for getting one are smoking (more than 90 percent of folks who get them are current or former smokers), high blood pressure, hardening of the arteries, male gender (men are four times more likely to get them), and a family history.

Abdominal aortic aneurysms have few symptoms, so a physical exam and ultrasound are important preventive measures. At my patients' annual physicals, I listen with my stethoscope for abnormal sounds that might suggest an aneurysm. I also feel for an abdominal mass, but that is not always possible in obese patients. If I suspect an aneurysm, an ultrasound of the abdominal aorta is my next step. If an aneurysm has reached 5.5 centimeters in diameter, it needs to be repaired either by traditional surgery or new nonsurgical radiology repair techniques. If your aneurysm is smaller than that, "watchful waiting" with yearly sonograms is OK - unless it grows more than one centimeter a year.

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Men and women, 'pears' and 'apples,' and genetics

Q: Why do men accumulate their fat in the middle and women tend to accumulate their fat on the hips, thighs, and rear?

A: It's genetics. A man's fat and a female's fat are as different as "apples" and "pears."

The "pear" shape is classically a woman's; the "apple" shape is seen in men, but also in some obese women.

The bad news is that belly fat has been linked to many obesity-related diseases including heart disease and diabetes. It's estrogen-rich, and places women at higher risk of estrogen-driven cancers like breast cancer. Women are generally protected from these obesity-related disorders until menopause, when their ovarian hormone levels drop and fat storage tends to shift from their rears to their waists. "Pears" are less likely to suffer from diabetes, heart disease, and estrogen-driven cancers, but are more likely to suffer from osteoporosis, varicose veins, and cellulite. "Pears" must watch fats closely since the fat cells in hips, thighs, and buttocks are like "fat magnets."

Mitchell Hecht specializes in internal medicine. Send questions to him at: "Ask Dr. H," Box 767787, Atlanta, Ga. 30076. Due to the volume of mail, personal replies are not possible.