Aortic aneurysm associated with decreased incidence of atherosclerosis

09/13/05

New Haven, Conn.-Oddly enough, having an aneurysm in the ascending aorta is significantly associated with decreased incidence of atherosclerosis, according to a study by Yale School of Medicine researchers published this month in Chest.

An aortic aneurysm is a widening of the major artery leading from the heart that may rupture, causing hemorrhage, or may split into layers, jeopardizing blood flow to internal organs. When split into layers it is called "aortic dissection."

"This is a silver lining in the cloud of aneurysm disease," said John Elefteriades, M.D., section chief of cardiothoracic surgery in the Department of Surgery and senior author of the study.

He said the study was prompted by clinical observations that patients with aortic aneurysm and dissection-men and women, young and elderly-had a noteworthy absence of atherosclerosis. Most patients, Elefteriades said, begin showing the earliest signs of atherosclerosis in their 20s. "Surprisingly, the arteries of the patients with ascending aortic aneurysm looked like a baby's or a young child's," he said.

This study included 64 patients between 36 and 82 years of age with aortic aneurysm or dissection. The control group consisted of 86 trauma patients who had undergone computerized tomography of the chest. The lower prevalence of calcification in patients with ascending aortic aneurysm and dissection was independent of the major risk factors for heart disease-age, gender, high cholesterol, hypertension, diabetes and smoking history. In fact, the aneurysm patients appeared to be significantly protected despite a higher cholesterol level.

In earlier studies Elefteriades and his colleagues demonstrated the heritable nature of ascending aortic aneurysm and dissection. He said it is conceivable that the mutations inherent in aortic aneurysm also play a role in the atherosclerotic process.

"If patients with certain heritable aortic pathologies exhibit decreased systemic atherosclerosis, this finding would be important by virtue of providing new insights into the pathophysiology of the most common cause of death in the western world, heart and blood vessel disease due to atherosclerosis," he said.

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