期刊
JOURNAL OF THE AMERICAN HEART ASSOCIATION
卷 4, 期 1, 页码 -出版社
WILEY
DOI: 10.1161/JAHA.114.001513
关键词
aneurysm; aorta; dissection; epidemiology; risk factor
资金
- Swedish Cancer Society
- Swedish Medical Research Council
- Swedish Dairy Association
- Albert Pahlsson and Gunnar Nilsson Foundations
- Malmo City Council
- Hulda Almroths Research Foundation
- Skane University Hospital in Malmo
- Ernhold Lundstroms Research Foundation
- US National Institutes of Health [HL080025, HL098283]
- Burroughs Wellcome Fund
- Medical Faculty of Lund University
- Albert Pahlsson Research Foundation
- Crafoord Foundation
- Swedish National Health Service
- Hulda and Conrad Mossfelt Foundation
- King Gustaf V and Queen Victoria Fund
- Lennart Hanssons Memorial Fund
- Marianne and Marcus Wallenberg Foundation
- Knut and Alice Wallenberg Foundation
- Swedish Heart-Lung Foundation
- Swedish Research Council
- Skane University Hospital in Lund
- Quest Diagnostics
- NATIONAL HEART, LUNG, AND BLOOD INSTITUTE [K23HL080025, R01HL098283] Funding Source: NIH RePORTER
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 Malmo 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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