Determinants of Aortic Root Dilatation and Reference Values Among Young Adults Over a 20-Year Period: Coronary Artery Risk Development in Young Adults Study.
Aortic size increases with age, but factors related to such dilatation in healthy young adult population have not been studied. We aim to evaluate changes in aortic dimensions and its principal correlates among young adults over a 20-year time period. Reference values for aortic dimensions in young adults by echocardiography are also provided. Healthy Coronary Artery Risk Development in Young Adults (CARDIA) study participants aged 23 to 35 years in 1990-1991 (n=3051) were included after excluding 18 individuals with significant valvular dysfunction. Aortic root diameter (ARD) by M-mode echocardiography at year-5 (43.7% men; age, 30.2 ± 3.6 years) and year-25 CARDIA exams was obtained. Univariable and multivariable analyses were performed to assess associations of ARD with clinical data at years-5 and -25. ARD from year-5 was used to establish reference values of ARD in healthy young adults. ARD at year-25 was greater in men (33.3 ± 3.7 versus 28.7 ± 3.4 mm; P<0.001) and in whites (30.9 ± 4.3 versus 30.5 ± 4.1 mm; P=0.006). On multivariable analysis, ARD at year-25 was positively correlated with male sex, white ethnicity, age, height, weight, 20-year gain in weight, active smoking at baseline, and 20-year increase in diastolic, systolic, and mean arterial pressure. A figure showing the estimated 95th percentile of ARD by age and body surface area stratified by race and sex is provided. This study demonstrates that smoking, blood pressure, and increase in body weight are the main modifiable correlates of aortic root dilation during young adulthood. Our study also provides reference values for ARD in young adults.
From the Department of Medicine and Medical Genetics, Johns Hopkins University, Baltimore, MD (G.T.-T., A.L.C.A., E.-Y.C., O.G., H.C.D., J.A.C.L.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (G.T.-T., D.G.-D., A.E.); Department of Epidemiology, University of Minnesota, Minneapolis (D.R.J.); Department of Preventive Medicine, Northwestern University, Chicago, IL (K.L.); Kaiser Permanente, Division of Research, Oakland, CA (S.S.); Division of Preventive Medicine, University of Alabama, Birmingham (C.E.L.); and Division of Cardiology, Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.G.). gteixido@vhebron.net.
Gisela
G
Teixido-Tura
From the Department of Medicine and Medical Genetics, Johns Hopkins University, Baltimore, MD (G.T.-T., A.L.C.A., E.-Y.C., O.G., H.C.D., J.A.C.L.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (G.T.-T., D.G.-D., A.E.); Department of Epidemiology, University of Minnesota, Minneapolis (D.R.J.); Department of Preventive Medicine, Northwestern University, Chicago, IL (K.L.); Kaiser Permanente, Division of Research, Oakland, CA (S.S.); Division of Preventive Medicine, University of Alabama, Birmingham (C.E.L.); and Division of Cardiology, Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.G.).
Andre L C
AL
Almeida
From the Department of Medicine and Medical Genetics, Johns Hopkins University, Baltimore, MD (G.T.-T., A.L.C.A., E.-Y.C., O.G., H.C.D., J.A.C.L.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (G.T.-T., D.G.-D., A.E.); Department of Epidemiology, University of Minnesota, Minneapolis (D.R.J.); Department of Preventive Medicine, Northwestern University, Chicago, IL (K.L.); Kaiser Permanente, Division of Research, Oakland, CA (S.S.); Division of Preventive Medicine, University of Alabama, Birmingham (C.E.L.); and Division of Cardiology, Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.G.).
Eui-Young
EY
Choi
From the Department of Medicine and Medical Genetics, Johns Hopkins University, Baltimore, MD (G.T.-T., A.L.C.A., E.-Y.C., O.G., H.C.D., J.A.C.L.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (G.T.-T., D.G.-D., A.E.); Department of Epidemiology, University of Minnesota, Minneapolis (D.R.J.); Department of Preventive Medicine, Northwestern University, Chicago, IL (K.L.); Kaiser Permanente, Division of Research, Oakland, CA (S.S.); Division of Preventive Medicine, University of Alabama, Birmingham (C.E.L.); and Division of Cardiology, Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.G.).
Ola
O
Gjesdal
From the Department of Medicine and Medical Genetics, Johns Hopkins University, Baltimore, MD (G.T.-T., A.L.C.A., E.-Y.C., O.G., H.C.D., J.A.C.L.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (G.T.-T., D.G.-D., A.E.); Department of Epidemiology, University of Minnesota, Minneapolis (D.R.J.); Department of Preventive Medicine, Northwestern University, Chicago, IL (K.L.); Kaiser Permanente, Division of Research, Oakland, CA (S.S.); Division of Preventive Medicine, University of Alabama, Birmingham (C.E.L.); and Division of Cardiology, Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.G.).
David R
DR
Jacobs
From the Department of Medicine and Medical Genetics, Johns Hopkins University, Baltimore, MD (G.T.-T., A.L.C.A., E.-Y.C., O.G., H.C.D., J.A.C.L.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (G.T.-T., D.G.-D., A.E.); Department of Epidemiology, University of Minnesota, Minneapolis (D.R.J.); Department of Preventive Medicine, Northwestern University, Chicago, IL (K.L.); Kaiser Permanente, Division of Research, Oakland, CA (S.S.); Division of Preventive Medicine, University of Alabama, Birmingham (C.E.L.); and Division of Cardiology, Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.G.).
Harry C
HC
Dietz
From the Department of Medicine and Medical Genetics, Johns Hopkins University, Baltimore, MD (G.T.-T., A.L.C.A., E.-Y.C., O.G., H.C.D., J.A.C.L.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (G.T.-T., D.G.-D., A.E.); Department of Epidemiology, University of Minnesota, Minneapolis (D.R.J.); Department of Preventive Medicine, Northwestern University, Chicago, IL (K.L.); Kaiser Permanente, Division of Research, Oakland, CA (S.S.); Division of Preventive Medicine, University of Alabama, Birmingham (C.E.L.); and Division of Cardiology, Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.G.).
Kiang
K
Liu
From the Department of Medicine and Medical Genetics, Johns Hopkins University, Baltimore, MD (G.T.-T., A.L.C.A., E.-Y.C., O.G., H.C.D., J.A.C.L.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (G.T.-T., D.G.-D., A.E.); Department of Epidemiology, University of Minnesota, Minneapolis (D.R.J.); Department of Preventive Medicine, Northwestern University, Chicago, IL (K.L.); Kaiser Permanente, Division of Research, Oakland, CA (S.S.); Division of Preventive Medicine, University of Alabama, Birmingham (C.E.L.); and Division of Cardiology, Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.G.).
Stephen
S
Sidney
From the Department of Medicine and Medical Genetics, Johns Hopkins University, Baltimore, MD (G.T.-T., A.L.C.A., E.-Y.C., O.G., H.C.D., J.A.C.L.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (G.T.-T., D.G.-D., A.E.); Department of Epidemiology, University of Minnesota, Minneapolis (D.R.J.); Department of Preventive Medicine, Northwestern University, Chicago, IL (K.L.); Kaiser Permanente, Division of Research, Oakland, CA (S.S.); Division of Preventive Medicine, University of Alabama, Birmingham (C.E.L.); and Division of Cardiology, Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.G.).
Cora E
CE
Lewis
From the Department of Medicine and Medical Genetics, Johns Hopkins University, Baltimore, MD (G.T.-T., A.L.C.A., E.-Y.C., O.G., H.C.D., J.A.C.L.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (G.T.-T., D.G.-D., A.E.); Department of Epidemiology, University of Minnesota, Minneapolis (D.R.J.); Department of Preventive Medicine, Northwestern University, Chicago, IL (K.L.); Kaiser Permanente, Division of Research, Oakland, CA (S.S.); Division of Preventive Medicine, University of Alabama, Birmingham (C.E.L.); and Division of Cardiology, Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.G.).
David
D
Garcia-Dorado
From the Department of Medicine and Medical Genetics, Johns Hopkins University, Baltimore, MD (G.T.-T., A.L.C.A., E.-Y.C., O.G., H.C.D., J.A.C.L.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (G.T.-T., D.G.-D., A.E.); Department of Epidemiology, University of Minnesota, Minneapolis (D.R.J.); Department of Preventive Medicine, Northwestern University, Chicago, IL (K.L.); Kaiser Permanente, Division of Research, Oakland, CA (S.S.); Division of Preventive Medicine, University of Alabama, Birmingham (C.E.L.); and Division of Cardiology, Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.G.).
Artur
A
Evangelista
From the Department of Medicine and Medical Genetics, Johns Hopkins University, Baltimore, MD (G.T.-T., A.L.C.A., E.-Y.C., O.G., H.C.D., J.A.C.L.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (G.T.-T., D.G.-D., A.E.); Department of Epidemiology, University of Minnesota, Minneapolis (D.R.J.); Department of Preventive Medicine, Northwestern University, Chicago, IL (K.L.); Kaiser Permanente, Division of Research, Oakland, CA (S.S.); Division of Preventive Medicine, University of Alabama, Birmingham (C.E.L.); and Division of Cardiology, Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.G.).
Samuel
S
Gidding
From the Department of Medicine and Medical Genetics, Johns Hopkins University, Baltimore, MD (G.T.-T., A.L.C.A., E.-Y.C., O.G., H.C.D., J.A.C.L.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (G.T.-T., D.G.-D., A.E.); Department of Epidemiology, University of Minnesota, Minneapolis (D.R.J.); Department of Preventive Medicine, Northwestern University, Chicago, IL (K.L.); Kaiser Permanente, Division of Research, Oakland, CA (S.S.); Division of Preventive Medicine, University of Alabama, Birmingham (C.E.L.); and Division of Cardiology, Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.G.).
João A C
JA
Lima
D000293:Adolescent; D000328:Adult; D000886:Anthropometry; D001011:Aorta / Q000000981:diagnostic imaging / Q000254:growth & development* / Q000473:pathology; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000473:pathology; D058070:Asymptomatic Diseases; D003327:Coronary Disease / Q000453:epidemiology* / Q000473:pathology; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging / Q000473:pathology; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012015:Reference Standards; D012306:Risk; D012727:Sex Characteristics; D014463:Ultrasonography; D014481:United States / Q000453:epidemiology; D055815:Young Adult
aorta; aortic aneurysm; aortic diseases; echocardiography