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CLINICAL RESEARCH: AORTIC ANEURYSM

Is aortic dilatation an atherosclerosis-related process?

Clinical, laboratory, and transesophageal echocardiographiccorrelates of thoracic aortic dimensions in the populationwith implications for thoracic aortic aneurysm formation

Yoram Agmon, MD^*, Bijoy K. Khandheria, MD^*,*, Irene Meissner, MD, Gary L. Schwartz, MD, JoRean D. Sicks, MS, Angela J. Fought, BS, W. Michael O'Fallon, PhD, David O. Wiebers, MD and A. Jamil Tajik, MD^*

^* Division of Cardiovascular Diseases and Internal Medicine, Rochester, Minnesota, USA
Department of Neurology, Rochester, Minnesota, USA
Division of Hypertension and Internal Medicine, Rochester, Minnesota, USA
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA

Manuscript received October 14, 2002; revised manuscript received April 30, 2003, accepted May 9, 2003.

^* Reprint requests and correspondence: Dr. Bijoy K. Khandheria, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.
khandheria{at}mayo.edu

OBJECTIVES: The study determined, in a population-based setting, whether dilatation of the thoracic aorta is an atherosclerosis-related process.

BACKGROUND: The role of atherosclerosis in thoracic aortic dilatation and aneurysm formation is poorly defined.

METHODS: The dimensions of the thoracic aorta were measured with transesophageal echocardiography in 373 subjects participating in a population-based study (median age 66 years; 52% men). The associations between clinical and laboratory atherosclerosis risk factors, aortic atherosclerotic plaques, and aortic dimensions were examined.

RESULTS: Age, male gender, and body surface area (BSA) jointly accounted for 41%, 31%, 38%, and 47% of the variability in diameters of the sinuses of Valsalva, ascending aorta, aortic arch, and descending aorta, respectively. Adjusting for age, gender, and BSA: 1) smoking was associated with a greater aortic arch diameter, and diastolic blood pressure and diabetes were each associated with a greater descending aorta diameter (p < 0.05); 2) atherosclerotic plaques in the descending aorta were associated with a greater descending aorta diameter (0.18 ± 0.08-mm increase in diameter per 1-mm increase in plaque thickness; p = 0.02); and 3) minor negative associations were noted between atherosclerotic plaques and risk factors for atherosclerosis and the dimensions of the proximal thoracic aorta. Notably, atherosclerosis risk factors and plaque variables each accounted for <2% of the variability in aortic dimensions, adjusting for age, gender, and BSA.

CONCLUSIONS: Age, gender, and BSA are major determinants of thoracic aortic dimensions. Atherosclerosis risk factors and aortic atherosclerotic plaques are weakly associated with distal aortic dilatation, suggesting that atherosclerosis plays a minor role in aortic dilatation in the population.

Abbreviations and Acronyms   BMI   body mass index   BP   blood pressure   BSA   body surface area   HDL   high-density lipoprotein   SPARC   Stroke Prevention: Assessment of Risk in a Community study   TEE   transesophageal echocardiography

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