title: Out of proportion proximal aortic remodeling: A subclinical marker of early vascular ageing? A systematic review.
abstract: BACKGROUND
  Proximal aorta stiffens and dilates with aging. Aortic stiffening is a well known process, carrying prognostic implications. On the contrary, few data are available about proximal aorta dilatation. It is not known if "out of proportion" aortic remodeling, i.e. in excess for age, sex and body size, could be a marker of early vascular ageing; there is controversy on how it would be accelerated by classical risk factors or would associate with validated markers of cardiovascular organ damage.
  
  
  OBJECTIVE
  We conducted a systematic review in order to evaluate the determinants of proximal aortic dimensions, focusing on the association with arterial hypertension, cardiovascular risk factors and markers of organ damage.
  Age, gender and body size explain 40-50% of the variability of aortic dimensions; genetic predisposition accounts for nearly 20%. Among cardiovascular risk factors obesity and hypertension seem to be associated with faster outward aortic remodeling. Arterial hypertension would account for a 0.60-0.78 mm greater diameter at the ascending aorta. Moreover, in hypertension, left ventricular mass showed a strict association with aortic diameter in nearly all studies. Other classical risk factors for atherogenesis such as dyslipidemia and smoking showed a weak influence on proximal aortic dimensions. No study reported a greater aortic remodeling in diabetics.
  
  
  CONCLUSIONS
  "Out of proportion" proximal aortic remodeling, could represent a subclinical marker of early vascular ageing, describing the cumulative influence of genetic predisposition, arterial hypertension and obesity.
authors: Department of Medical Sciences, Division of Internal Medicine, Hypertension Unit, University Hospital 'S. Giovanni Battista', University of Torino, Italy.
authors: Francesco
authors: F
authors: Tosello
authors: Department of Medical Sciences, Division of Internal Medicine, Hypertension Unit, University Hospital 'S. Giovanni Battista', University of Torino, Italy.
authors: Dario
authors: D
authors: Leone
authors: Pharmacology Department and INSERM U 970 Hôpital Européen Georges Pompidou, Paris, France.
authors: Stéphane
authors: S
authors: Laurent
authors: Department of Medical Sciences, Division of Internal Medicine, Hypertension Unit, University Hospital 'S. Giovanni Battista', University of Torino, Italy.
authors: Franco
authors: F
authors: Veglio
authors: Department of Medical Sciences, Division of Internal Medicine, Hypertension Unit, University Hospital 'S. Giovanni Battista', University of Torino, Italy. Electronic address: alberto.milan@unito.it.
authors: Alberto
authors: A
authors: Milan
mesh_terms: D000375:Aging / Q000473:pathology / Q000502:physiology; D001013:Aorta, Thoracic / Q000473:pathology / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D006801:Humans; D009929:Organ Size; D012307:Risk Factors; D066253:Vascular Remodeling; D059289:Vascular Stiffness
keywords: Aortic dilatation; Aortic remodeling; Ascending aorta; Proximal aorta; Risk factors; Vascular ageing