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(Chest. 2005;128:1580-1586.)
© 2005 American College of Chest Physicians

Ascending Thoracic Aneurysms Are Associated With Decreased Systemic Atherosclerosis*

Hardean Achneck, MD; Biren Modi, MD; Coralie Shaw, MD; John Rizzo, PhD; Gonzalo Albornoz, MD; Daniel Fusco, MD and John Elefteriades, MD

* From the Section of Cardiothoracic Surgery (Drs. Achneck, Modi, Albornoz, Fusco, and Elefteriades), and the Department of Diagnostic Imaging (Dr. Shaw), Yale University School of Medicine, New Haven, CT; and the Division of Evaluative Sciences (Dr. Rizzo), Department of Preventive Medicine at Stony Brook University School of Medicine, Stony Brook, NY.

Correspondence to: John A. Elefteriades, MD, Section of Cardiothoracic Surgery, Yale University School of Medicine, 333 Cedar St, 121 FMB, New Haven, CT, 06520; e-mail: john.elefteriades{at}yale.edu

Study objectives: We noted clinically that patients with aortic root aneurysms and dissections seemed to have little systemic atherosclerosis. It is our objective to determine whether there is a negative association between ascending thoracic aneurysms and systemic atherosclerosis.

Design: Atherosclerosis was quantified by evaluating noncontrast CT images of the chest and scoring the degree of calcifications as a marker for atherosclerosis in the coronary arteries and aorta.

Patients: The degree of calcification was compared in 64 patients with aortic root aneurysm (annuloaortic ectasia, 31 patients; type A dissection, 33 patients) vs 86 control subjects. Multivariable analysis was applied to test for an association between aortic root aneurysms and systemic calcification independent of risk factors for atherosclerosis.

Results: Multivariable analysis revealed that patients with ascending aortic aneurysms of the annuloaortic ectasia type and patients with type A dissections had significantly lower overall calcification scores in their arterial vessels compared to patients in the control group (p = 0.03 and p < 0.0001, respectively). These results were independent of all other risk factors for atherosclerosis. Smoking, dyslipidemia, diabetes, and age were all found to increase the degree of atherosclerosis (p < 0.01 to 0.05).

Conclusions: Aortic root pathology (annuloaortic ectasia or type A dissection) is associated with decreased systemic atherosclerosis. It is possible that a mechanism exists whereby the same genetic mutations predisposing patients to ascending aortic aneurysms also exert a protective effect against systemic atherosclerosis.

Key Words: aneurysm • aorta • atherosclerosis • dissection






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