While a relationship between large infrarenal aortic diameter and both cardiovascular disease (CVD) prevalence and all-cause mortality has been previously suggested, there is also evidence that small aortic size may also be associated with increased CVD risk. We examined a total of 4882 elderly (>50 years) participants (mean age 69.4) by duplex ultrasound to assess infrarenal abdominal aortic diameters and correlated these with each individual's history of CVDs, including ischaemic heart disease (IHD), and associated risk factors. CVD prevalence showed a U-shaped relationship with aortic size (figure) and was significantly elevated in the upper and lower 12.5% tails of the aortic size distributions. These associations remained significant following adjustment for age, sex, diabetes, hypertension, dyslipidemia, obesity (body mass index) and smoking. A sub-group of 1032 participants were prospectively followed for 5 years to determine subsequent major adverse cardiovascular events (MACE) or death. In this group, small aortic size showed a significant unadjusted association with increased risk of MACE, while large aortic size showed an unadjusted association with (all-cause) mortality.
The largest and smallest body surface area adjusted infrarenal aortic sizes appear to have a bimodal association with the prevalence of ischaemic heart disease. Small aortic size may also be a prospective indicator of poor CVD-related outcomes. Assessment of infrarenal aortic size may not only identify those with aneurysmal disease but also improve global CVD-event risk prediction.
Locally weighted smoothed scatterplot showing the relationship between infrarenal aortic size and history of cardiovascular disease. ASI?=?absolute aortic diameter(cm)/ body surface area (m2).