Agmon Yoram, Khandheria Bijoy K, Meissner Irene, Schwartz Gary L, Sicks JoRean D, Fought Angela J, O'Fallon W Michael, Wiebers David O, Tajik A Jamil
Division of Cardiovascular Diseases and Internal Medicine, Rochester, Minnesota 55905, USA.
J Am Coll Cardiol. 2003 Sep 17;42(6):1076-83. doi: 10.1016/s0735-1097(03)00922-7.
The study determined, in a population-based setting, whether dilatation of the thoracic aorta is an atherosclerosis-related process.
The role of atherosclerosis in thoracic aortic dilatation and aneurysm formation is poorly defined.
The dimensions of the thoracic aorta were measured with transesophageal echocardiography in 373 subjects participating in a population-based study (median age 66 years; 52% men). The associations between clinical and laboratory atherosclerosis risk factors, aortic atherosclerotic plaques, and aortic dimensions were examined.
Age, male gender, and body surface area (BSA) jointly accounted for 41%, 31%, 38%, and 47% of the variability in diameters of the sinuses of Valsalva, ascending aorta, aortic arch, and descending aorta, respectively. Adjusting for age, gender, and BSA: 1) smoking was associated with a greater aortic arch diameter, and diastolic blood pressure and diabetes were each associated with a greater descending aorta diameter (p < 0.05); 2) atherosclerotic plaques in the descending aorta were associated with a greater descending aorta diameter (0.18 +/- 0.08-mm increase in diameter per 1-mm increase in plaque thickness; p = 0.02); and 3) minor negative associations were noted between atherosclerotic plaques and risk factors for atherosclerosis and the dimensions of the proximal thoracic aorta. Notably, atherosclerosis risk factors and plaque variables each accounted for <2% of the variability in aortic dimensions, adjusting for age, gender, and BSA.
Age, gender, and BSA are major determinants of thoracic aortic dimensions. Atherosclerosis risk factors and aortic atherosclerotic plaques are weakly associated with distal aortic dilatation, suggesting that atherosclerosis plays a minor role in aortic dilatation in the population.
本研究在基于人群的环境中确定胸主动脉扩张是否为与动脉粥样硬化相关的过程。
动脉粥样硬化在胸主动脉扩张和动脉瘤形成中的作用尚不明确。
采用经食管超声心动图测量了参与一项基于人群研究的373名受试者（中位年龄66岁；52%为男性）的胸主动脉尺寸。研究了临床和实验室动脉粥样硬化危险因素、主动脉粥样硬化斑块与主动脉尺寸之间的关联。
年龄、男性性别和体表面积（BSA）分别共同解释了主动脉瓣窦、升主动脉、主动脉弓和降主动脉直径变异性的41%、31%、38%和47%。在调整年龄、性别和BSA后：1）吸烟与主动脉弓直径增大相关，舒张压和糖尿病均与降主动脉直径增大相关（p<0.05）；2）降主动脉中的动脉粥样硬化斑块与降主动脉直径增大相关（斑块厚度每增加1mm，直径增加0.18±0.08mm；p=0.02）；3）在动脉粥样硬化斑块与动脉粥样硬化危险因素及胸主动脉近端尺寸之间发现了轻微的负相关。值得注意的是，在调整年龄、性别和BSA后，动脉粥样硬化危险因素和斑块变量各自仅占主动脉尺寸变异性的不到2%。
年龄、性别和BSA是胸主动脉尺寸的主要决定因素。动脉粥样硬化危险因素和主动脉粥样硬化斑块与远端主动脉扩张弱相关，提示动脉粥样硬化在人群主动脉扩张中起次要作用。
