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Population-Based Risk Factors for Ascending, Arch, Descending, and Abdominal Aortic Dilations for 60-74–Year-Old Individuals

2021; Elsevier BV; Volume: 78; Issue: 3 Linguagem: Inglês

10.1016/j.jacc.2021.04.094

1558-3597

Lasse M. Obel, Axel Cosmus Pyndt Diederichsen, Flemming Hald Steffensen, Lars Frost, Jess Lambrechtsen, Martin Busk, Gražina Urbonavičienė, Kenneth Egstrup, Marek Karon, Lars Melholt Rasmussen, Oke Gerke, Anders S. Bøvling, Jes S. Lindholt,

Renal and Vascular Pathologies

Background: Aortic dilations (ectasies and aneurysms) may occur on any segment of the aorta.Pathogenesis varies between locations, suggesting that etiology and risk factors may differ.In spite of this discrepancy, guidelines recommend screening of the whole aorta if one segmental dilation is discovered.Objectives: To determine the most dominant predictors for dilations at the ascending, arch, descending, and abdominal part of the aorta, and to establish comprehensive risk factor profiles for each aortic segment.Methods: Individuals aged 60-74 years were randomly selected to participate in the cardiovascular screening trials DANCAVAS I+II.Participants underwent cardiovascular risk assessments including blood samples, blood pressures, medical records, and non-contrast CTscans.Adjusted odds ratios (aOR) for potential risk factors of dilations were estimated by multivariate logistic analyses. Results:The study-population consisted of 14,989 participants (14,235 males, 754 females) with an average age of 68 ±4 years.The highest aORs were observed when co-existing aortic dilations were present.Other noteworthy predictors included co-existing iliac dilations, hypertension, increasing body surface area, male sex, familial disposition, and atrial fibrillation, which were present in various combinations for the different aortic parts.Smoking and acute myocardial infarction were inversely associated with ascending and abdominal dilations.Diabetes was a shared protective factor.Conclusions: Risk factors differ for aortic dilations between locations.The most dominant predictor for having a dilation at any aortic segment is the presence of an aortic dilation elsewhere.This supports current guidelines when recommending a full screening of the aorta if a focal aortic dilation is discovered. Condensed AbstractAccording to this population-based, cross-sectional study including 14,989 randomly selected participants (14,235 males, 754 females): the most dominant predictor for having an aortic dilation at any aortic segment, is the presence of co-existing aortic dilations.This calls for a total aortic scan, when a focal dilation is present. the iliac arteries should be evaluated for dilations, when an aortic dilation is present  several modifiable, cardiovascular risk factors are associated with aortic dilations, but differences in risk factor profiles are observed for the different aortic segments  prediction formulae for calculation of expected normal thoracic and abdominal aortic diameters have been created