Risk profiles for aortic dissection and ruptured or surgically treated aneurysms: a prospective cohort study.

J Am Heart Assoc
Authors
Keywords
Abstract

BACKGROUND: Community screening to guide preventive interventions for acute aortic disease has been recommended in high-risk individuals. We sought to prospectively assess risk factors in the general population for aortic dissection (AD) and severe aneurysmal disease in the thoracic and abdominal aorta.

METHODS AND RESULTS: We studied the incidence of AD and ruptured or surgically treated aneurysms in the abdominal (AAA) or thoracic aorta (TAA) in 30 412 individuals without diagnosis of aortic disease at baseline from a contemporary, prospective cohort of middle-aged individuals, the Malmö Diet and Cancer study. During up to 20 years of follow-up (median 16 years), the incidence rate per 100 000 patient-years at risk was 15 (95% CI 11.7 to 18.9) for AD, 27 (95% CI 22.5 to 32.1) for AAA, and 9 (95% CI 6.8 to 12.6) for TAA. The acute and in-hospital mortality was 39% for AD, 34% for ruptured AAA, and 41% for ruptured TAA. Hypertension was present in 86% of individuals who subsequently developed AD, was strongly associated with incident AD (hazard ratio [HR] 2.64, 95% CI 1.33 to 5.25), and conferred a population-attributable risk of 54%. Hypertension was also a risk factor for AAA with a smaller effect. Smoking (HR 5.07, 95% CI 3.52 to 7.29) and high apolipoprotein B/A1 ratio (HR 2.48, 95% CI 1.73 to 3.54) were strongly associated with AAA and conferred a population-attributable risk of 47% and 25%, respectively. Smoking was also a risk factor for AD and TAA with smaller effects.

CONCLUSIONS: This large prospective study identified distinct risk factor profiles for different aortic diseases in the general population. Hypertension accounted for more than half of the population risk for AD, and smoking for half of the population risk of AAA.

Year of Publication
2015
Journal
J Am Heart Assoc
Volume
4
Issue
1
Pages
e001513
Date Published
2015 Jan 21
ISSN
2047-9980
URL
DOI
10.1161/JAHA.114.001513
PubMed ID
25609416
PubMed Central ID
PMC4330075
Links
Grant list
K23 HL080025 / HL / NHLBI NIH HHS / United States
R01 HL098283 / HL / NHLBI NIH HHS / United States
HL080025 / HL / NHLBI NIH HHS / United States
HL098283 / HL / NHLBI NIH HHS / United States