Risk Profiles for Aortic Dissection and Ruptured or Surgically Treated Aneurysms: A Prospective Cohort Study

Journal of the American Heart Association - Tập 4 Số 1 - 2015
Maya Landenhed1, Gunnar Engström2, Anders Gottsäter3, Michael P. Caulfield4, Bo Hedblad2, Christopher Newton‐Cheh5,6, Olle Melander7, J. G. Smith5,2,6,8
1Department of Cardiothoracic Surgery, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
2Cardiovascular Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden
3Vascular Center, Skåne University Hospital, Malmö, Sweden
4Michael P. Caulfield Department of Endocrinology & CVD, Quest Diagnostics Nichols Institute, San Juan Capistrano, CA
5Broad Institute of Harvard and MIT, Cambridge, MA
6Cardiovascular Research Center and the Center for Human Genetic Research, Harvard Medical School and Massachusetts General Hospital, Boston, MA
7Department of Internal Medicine, Clinical Sciences, Lund University and Skåne University Hospital, Malmö, Sweden
8Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden

Tóm tắt

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 .

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Journal of the American Heart Association

Tập 4 Số 1

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