title: Risk profiles for aortic dissection and ruptured or surgically treated aneurysms: a prospective cohort study.
abstract: 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.
  
  
  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.
authors.affiliation: Department of Cardiothoracic Surgery, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden (M.L.).
authors.forename: Maya
authors.initials: M
authors.lastname: Landenhed
authors.affiliation: Cardiovascular Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden (G.E., B.H., G.S.).
authors.forename: Gunnar
authors.initials: G
authors.lastname: Engström
authors.affiliation: Vascular Center, Skåne University Hospital, Malmö, Sweden (A.G.).
authors.forename: Anders
authors.initials: A
authors.lastname: Gottsäter
authors.affiliation: Department of Endocrinology & CVD, Quest Diagnostics Nichols Institute, San Juan Capistrano, CA (M.P.C.).
authors.forename: Michael P
authors.initials: MP
authors.lastname: Caulfield
authors.affiliation: Cardiovascular Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden (G.E., B.H., G.S.).
authors.forename: Bo
authors.initials: B
authors.lastname: Hedblad
authors.affiliation: Cardiovascular Research Center and the Center for Human Genetic Research, Harvard Medical School and Massachusetts General Hospital, Boston, MA (C.N.C., G.S.) Broad Institute of Harvard and MIT, Cambridge, MA (C.N.C., G.S.).
authors.forename: Christopher
authors.initials: C
authors.lastname: Newton-Cheh
authors.affiliation: Department of Internal Medicine, Clinical Sciences, Lund University and Skåne University Hospital, Malmö, Sweden (O.M.).
authors.forename: Olle
authors.initials: O
authors.lastname: Melander
authors.affiliation: Cardiovascular Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden (G.E., B.H., G.S.) Cardiovascular Research Center and the Center for Human Genetic Research, Harvard Medical School and Massachusetts General Hospital, Boston, MA (C.N.C., G.S.) Broad Institute of Harvard and MIT, Cambridge, MA (C.N.C., G.S.) Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden (G.S.).
authors.forename: J Gustav
authors.initials: JG
authors.lastname: Smith
mesh_terms: D017677:Age Distribution; D000784:Aortic Dissection / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D017542:Aneurysm, Ruptured / Q000453:epidemiology* / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology* / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000453:epidemiology* / Q000601:surgery; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D016019:Survival Analysis; D013548:Sweden; D016896:Treatment Outcome
keywords: aneurysm; aorta; dissection; epidemiology; risk factor