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Differences in Atherosclerotic Profiles Between Patients With Thoracic and Abdominal Aortic Aneurysms

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Differences in atherosclerotic profiles between patients with thoracic aortic aneurysm (TAA) and patients with abdominal aortic aneurysm (AAA) have not been studied. We retrospectively studied the clinical records of 343 consecutive patients (132 TAA and 211 AAA) who were admitted to our hospital for elective repair of aortic aneurysms between July 2001 and December 2004. Clinical variables were compared between patients with TAA and those with AAA by using a univariate analysis, and those achieving statistical significance were subsequently assessed in a multivariate analysis. The incidence of coronary artery disease (CAD) (53% vs 23%, p <0.0001), 3-vessel coronary disease (41% vs 10%, p <0.0001), male gender (86% vs 74%, p <0.01), smoker (88% vs 76%, p <0.01), chronic obstructive pulmonary disease (COPD) (30% vs 15%, p <0.01), and diabetes mellitus (39% vs 23%, p <0.01) were significantly higher in patients with AAA than in those with TAA. In contrast, the incidence of hypertension (91% vs 81%, p <0.05), saccular-type aneurysm (61% vs 7%, p <0.0001), and body mass index (24.1 ± 3.1 vs 23.2 ± 3.5, p <0.05) were significantly higher in patients with TAA than in those with AAA. Multivariate stepwise logistic analysis revealed that CAD (odds ratio [OR] 3.65; 95% confidence interval [CI] 2.12 to 6.42; p <0.0001), COPD (OR 2.05; 95% CI 1.11 to 3.89; p <0.05), and diabetes mellitus (OR 1.85; 95% CI 1.06 to 3.27; p <0.05) were associated with AAA, and that body mass index (OR 9.39; 95% CI 2.0 to 46.8; p <0.01), hypertension (OR 3.09; 95% CI 1.48 to 6.87; p <0.01), and cerebral infarction (OR 2.83; 95% CI 1.25 to 6.50; p <0.05) were associated with TAA. In conclusion, atherosclerotic profiles are significantly different between patients with TAA and patients with AAA. This result suggests the possibility that mechanisms underlying the development of aortic aneurysms may differ between TAA and AAA, and, from the perspective of prevention, provides further stimulus for the modification of key risk factors for atherosclerosis.

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Methods

We retrospectively studied the clinical data of 343 consecutive patients, comprising 132 patients with TAA and 211 patients with AAA, who were admitted to our hospital for elective repair of aortic aneurysms between July 2001 and December 2004. Exclusion criteria were Marfan syndrome (n = 10), Ehlers–Danlos syndrome (n = 0), annuloaortic ectasia (n = 11), bicuspid aortic valve (n = 2), infectious aortitis (n = 2), aortitis syndrome (n = 15), thoracoabdominal aortic aneurysm (n = 33), and

Results

The study population consisted of 132 patients with TAA and 211 with AAA. The baseline demographic and clinical characteristics of the patients are listed in Table 1. There were a significantly greater number of men and smokers in the AAA group compared with the TAA group. Body mass index was significantly less in patients with AAA than in those with TAA. Age, creatinine clearance, and C-reactive protein level were similar in the 2 groups. Comorbidities of the patients are also listed in Table 1

Discussion

In the present study, we sought to determine to what extent atherosclerosis contributes to the development of TAA and to elucidate the differences in atherosclerotic profiles between patients with TAA and those with AAA. The results of the study demonstrated that features of atherosclerosis disease and morphologies of the aneurysms differ considerably between patients with TAA and those with AAA. Specifically, patients with TAA were at risk for high body mass index, hypertension, and cerebral

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This work was supported by grants H16-009, H16-017, and H17-009 from the Health and Labor Sciences Research; research grants for Cardiovascular Disease 16C-6; and 18C-4 from the Ministry of Health, Labor and Welfare; and grants from the Japan Cardiovascular Research Foundation.

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