Trends in Thoracic Aortic Aneurysms and Dissection

In this issue of Circulation , Sidloff and colleagues1 have presented their findings that, among 18 World Health Organization member states over a period of 16 years (1994–2010), there has been a reduction in the age-standardized mortality from both thoracic aortic aneurysm and dissection. If one considers the United States, the United Kingdom, and Sweden, 3 countries that have published extensively on the prevalence and mortality of thoracic aortic disease, the trends are quite favorable: Mortality from thoracic aortic aneurysm has declined by ≈5% to 10% among men and 3% to 6% among women, and mortality from aortic dissection has declined by ≈2% to 3% among men and 1% to 2% among women. However, and not surprisingly, the investigators discovered heterogeneity among mortality trends by country. For example, for men with thoracic aortic aneurysms, although there was a statistically significant reduction in mortality over time in 13 of the 18 countries, in 3 countries, there was instead an increase in mortality. Similarly, for men suffering from aortic dissection, although there was again a statistically significant reduction in mortality over time in 13 of the 18 countries, in 1 country, there was a significant rise in mortality. Japan and Romania were the 2 countries with the most consistent increases in mortality.Article see p 2287The investigators then considered the impact of changing prevalence of risk factors on the changing mortality from thoracic aortic disease. In all of the countries studied, there was a decline in systolic blood pressure of up to 6% over time, and there was a linear relationship between systolic blood …