4.7 Article

Are Thoracic Aortic Aneurysm Patients at Increased Risk for Cardiovascular Diseases?

Journal

JOURNAL OF CLINICAL MEDICINE
Volume 12, Issue 1, Pages -

Publisher

MDPI
DOI: 10.3390/jcm12010272

Keywords

aortic dilatation; thoracic aortic aneurysm; abdominal aortic aneurysms; bicuspid aortic valve; coronary artery disease; cardiovascular risk management

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This study aimed to test whether thoracic aortic aneurysms are also associated with an increased cardiovascular risk burden. The results showed a higher prevalence of hypertension and a lower prevalence of diabetes in patients with thoracic aneurysms compared to the general population. Therefore, unlike abdominal aortic aneurysms, thoracic aneurysms do not need cardiovascular risk management in treatment guidelines, but hypertension should be treated.
Objectives: Abdominal aortic aneurysms are associated with a sharply increased cardiovascular risk. Cardiovascular risk management is therefore recommended in prevailing guidelines for abdominal aneurysm patients. It has been hypothesized that associated risk relates to loss of aortic compliance. If this hypothesis is correct, observations for abdominal aneurysms would also apply to thoracic aortic aneurysms. The objective of this study is to test whether thoracic aneurysms are also associated with an increased cardiovascular risk burden. Methods: Patients who underwent aortic valve or root surgery were included in the study (n = 239). Cardiovascular risk factors were studied and atherosclerosis was scored based on the preoperative coronary angiographies. Multivariate analyses were performed, controlling for cardiovascular risk factors and aortic valve morphology. Comparisons were made with the age- and gender-matched general population and non-aneurysm patients as control groups. A thoracic aortic aneurysm was defined as an aortic aneurysm of >= 45 mm. Results: Thoracic aortic aneurysm was not associated with an increased coronary atherosclerotic burden (p = 0.548). Comparison with the general population revealed a significantly higher prevalence of hypertension (61.4% vs. 32.2%, p < 0.001) and a lower prevalence of diabetes (1.4% vs. 13.1%, p = 0.001) in the thoracic aneurysm group. Conclusions: The extreme cardiovascular risk associated with abdominal aortic aneurysms is location-specific and not explained by loss of aortic compliance. Thoracic aortic aneurysm, in contrast to abdominal, is not part of the atherosclerotic disease spectrum and, therefore, cardiovascular risk management does not need to be implemented in treatment guidelines of isolated thoracic aneurysms. Hypertension should be treated.

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