Increased risk for thoracic aneurysms in female and familial abdominal aortic aneurysm patients

Abstract

Background: Thoracic aortic aneurysms (TAAs) occur more frequently in abdominal aortic aneurysm (AAA) patients than in the general population. The aim of the study was to investigate which AAA patients have an increased risk of developing TAA or thoraco-abdominal aortic aneurysm (TAAA), and if sex, genetic susceptibility for aneurysms, or conventional cardiovascular risk factors affect this risk.

Methods: Repeated computed tomography scans from consecutively diagnosed AAA patients were evaluated retrospectively to determine the prevalence, sequence, and location of multiple aortic aneurysms. Effects of sex, genetic predisposition for aneurysms (familial aneurysm, the presence of [likely] pathogenic variants in known aneurysm genes), and cardiovascular risk factors (age, smoking, hypertension, diabetes mellitus, and hypercholesterolemia) on the risk for TAA were analyzed. Five-year survival was used to evaluate the impact of having thoracic aneurysms on survival of AAA patients.

Results: On the first computed tomography scan, 10.8% of AAA patients had a TAA. During follow-up, an additional 5.1% of the AAA patients developed TAA and 2.4% developed TAAA. Female patients had a two-fold increase in risk for TAA, in particular for aneurysms of the descending aorta. A two-fold increase in risk for ascending TAA was observed in AAA patients reporting familial aneurysms. The 5-year survival of female TAAA patients was lower than that of AAA patients, independent of having a TAA.

Conclusions: Female AAA patients had a two-fold increase in risk for TAA, particularly in the descending aorta. Familial AAA patients had a two-fold increase in aneurysm risk for ascending aortic aneurysms. TAAA patients had a lower survival compared with TAA or AAA patients, specifically among female TAAA patients. TAA and TAAA developed during follow-up. Therefore, follow-up imaging of both the ascending and descending aorta after diagnosis of AAA may improve early detection of multiple aneurysms.

Keywords: Abdominal aortic aneurysm; Aneurysm gene; Aneurysm genetics; Aortic aneurysm follow-up study; Familial abdominal aortic aneurysm; Survival; Thoracic aortic aneurysm; Thoraco-abdominal aortic aneurysm.