Format

Send to

Choose Destination
J Am Heart Assoc. 2015 Jan 21;4(1):e001513. doi: 10.1161/JAHA.114.001513.

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

Author information

1
Department of Cardiothoracic Surgery, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden (M.L.).
2
Cardiovascular Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden (G.E., B.H., G.S.).
3
Vascular Center, Skåne University Hospital, Malmö, Sweden (A.G.).
4
Department of Endocrinology & CVD, Quest Diagnostics Nichols Institute, San Juan Capistrano, CA (M.P.C.).
5
Cardiovascular Research Center and the Center for Human Genetic Research, Harvard Medical School and Massachusetts General Hospital, Boston, MA (C.N.C., G.S.) Broad Institute of Harvard and MIT, Cambridge, MA (C.N.C., G.S.).
6
Department of Internal Medicine, Clinical Sciences, Lund University and Skåne University Hospital, Malmö, Sweden (O.M.).
7
Cardiovascular Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden (G.E., B.H., G.S.) Cardiovascular Research Center and the Center for Human Genetic Research, Harvard Medical School and Massachusetts General Hospital, Boston, MA (C.N.C., G.S.) Broad Institute of Harvard and MIT, Cambridge, MA (C.N.C., G.S.) Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden (G.S.).

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.

KEYWORDS:

aneurysm; aorta; dissection; epidemiology; risk factor

PMID:
25609416
PMCID:
PMC4330075
DOI:
10.1161/JAHA.114.001513
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Atypon Icon for PubMed Central
Loading ...
Support Center