Mortality from thoracic aortic diseases and associations with cardiovascular risk factors.
BACKGROUND
Temporal trends in mortality from thoracic aortic disease are unclear. This study examined trends in mortality from thoracic aortic aneurysm (TAA) and aortic dissection (AD) with the aim of identifying associations with trends in established cardiovascular risk factors.


RESULTS
TAA and AD mortality (1994-2010) using International Classification of Diseases codes was extracted from the World Health Organization mortality database and age standardized. World Health Organization InfoBase and International Mortality and Smoking Statistics provided risk factor data. Eighteen World Health Organization member states were included (Europe=13, Australasia=2, North America=2, Asia=1). Ecological regression was performed of temporal trends in cardiovascular risk factors (1946-2010) and independent correlations to mortality trends. TAA and AD mortality trends show substantial heterogeneity but are generally declining. TAA mortality has increased in Hungary, Romania, Japan, and Denmark, and AD mortality has increased in Romania and Japan; therefore, the mortality decline is not universal. A linear relationship exists between trends in systolic blood pressure, cholesterol, and body mass index and mortality from TAA. Body mass index demonstrated a negative linear association with female AD mortality, whereas trends in systolic blood pressure demonstrated a positive linear relationship with male AD mortality. Trends in smoking prevalence were not associated with TAA or AD mortality trends.


CONCLUSIONS
This population-level ecological regression provides evidence that mortality secondary to TAA and mortality secondary to AD are both in decline. Differences between countries could be explained by population-level changes in common cardiovascular risk factors. Public health measures could further reduce mortality from TAA and AD.
From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular Biomedical Research Unit, Leicester, UK (D.S., E.C., P.S., M.B., R.S.); and Department of Health Sciences, University of Leicester, Leicester, UK (J.T.). ds343@le.ac.uk.
David
D
Sidloff
From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular Biomedical Research Unit, Leicester, UK (D.S., E.C., P.S., M.B., R.S.); and Department of Health Sciences, University of Leicester, Leicester, UK (J.T.).
Edward
E
Choke
From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular Biomedical Research Unit, Leicester, UK (D.S., E.C., P.S., M.B., R.S.); and Department of Health Sciences, University of Leicester, Leicester, UK (J.T.).
Philip
P
Stather
From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular Biomedical Research Unit, Leicester, UK (D.S., E.C., P.S., M.B., R.S.); and Department of Health Sciences, University of Leicester, Leicester, UK (J.T.).
Matthew
M
Bown
From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular Biomedical Research Unit, Leicester, UK (D.S., E.C., P.S., M.B., R.S.); and Department of Health Sciences, University of Leicester, Leicester, UK (J.T.).
John
J
Thompson
From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular Biomedical Research Unit, Leicester, UK (D.S., E.C., P.S., M.B., R.S.); and Department of Health Sciences, University of Leicester, Leicester, UK (J.T.).
Robert
R
Sayers
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality*; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution
aneurysm; aorta; dissection; epidemiology; mortality; thorax