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. 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

Maya Landenhed  1 , Gunnar Engström  2 , Anders Gottsäter  3 , Michael P Caulfield  4 , Bo Hedblad  2 , Christopher Newton-Cheh  5 , Olle Melander  6 , J Gustav Smith  7
Affiliations

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

Maya Landenhed et al. J Am Heart Assoc. .

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.

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Figures

Figure 1.
Figure 1.
Validation of aortic dissections. AD indicates aortic dissection; TAA, thoracic aortic aneurysm.
Figure 2.
Figure 2.
Validation of thoracic aortic aneurysms (TAAs). AAA indicates abdominal aortic aneurysm; AD, aortic dissection.
Figure 3.
Figure 3.
Description of Malmö Diet and Cancer Study (MDCS) cohort with incident aortic dissection (AD) and ruptured or surgically treated aneurysms. Subjects in the MDCS cohort with a diagnosis of aortic disease before baseline who were excluded from the present study and subjects who were diagnosed with incident AD or ruptured or surgically treated aneurysms in the abdominal (AAA) or thoracic (TAA) aorta during up to 20 years of follow‐up. PYAR indicates person‐years at risk. *One patient was diagnosed with both AAA and TAA before baseline.
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