Blood Pressure, Hypertension, and the Risk of Aortic Dissection Incidence and Mortality: Results From the J-SCH Study, the UK Biobank Study, and a Meta-Analysis of Cohort Studies

Hibino, Makoto; Otaki, Yoichiro; Kobeissi, Elsa; Pan, Han; Hibino, Hiromi; Taddese, Henock; Majeed, Azeem; Verma, Subodh; Konta, Tsuneo; Yamagata, Kunihiro; Fujimoto, Shouichi; Tsuruya, Kazuhiko; Narita, Ichiei; Kasahara, Masato; Shibagaki, Yugo; Iseki, Kunitoshi; Moriyama, Toshiki; Kondo, Masahide; Asahi, Koichi; Watanabe, Tsuyoshi; Watanabe, Tetsu; Watanabe, Masafumi; Aune, Dagfinn

doi:10.1161/circulationaha.121.056546

Cited by 73 publications

(49 citation statements)

References 39 publications

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“… 18 In a study using prospective data from the Japan‐Specific Health Checkups and UK Biobank, hypertension was associated with a high risk of AoD in a dose‐dependent relationship. 19 The prevalence of hypertension has decreased from 47.0% in 1999 to 2000 to 41.7% in 2013 to 2014 and then increased to 45.4% in 2017 to 2018. 20 Notably, the prevalence of uncontrolled hypertension has also increased after 2014, plausibly contributing to the rising AoD deaths seen within this study.…”

Section: Discussionmentioning

confidence: 99%

Demographic and Regional Trends of Mortality in Patients With Aortic Dissection in the United States, 1999 to 2019

Nazir

Ariss

Minhas

et al. 2022

JAHA

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Background Aortic dissection (AoD) is associated with high morbidity and mortality. However, the burden of AoD mortality is not well characterized, and contemporary data and mortality trends in different demographic and geographic subgroups have not been described. Methods and Results Trends in AoD mortality were assessed using a cross‐sectional analysis of the Centers for Disease Control and Prevention Wide‐Ranging Online Data for Epidemiologic Research database. Crude and age‐adjusted mortality rates (AAMR) per 1 million people with associated annual percent changes were determined. Joinpoint regression was used to assess trends in the overall sample and different demographic (sex, race and ethnicity, age) and geographic subgroups. Between 1999 and 2019, a total of 86 855 AoD deaths occurred within the United States. In the overall population, AAMR was 21.1 per 1 million in 1999 and 21.3 in 2019. After an initial decline in mortality, AAMR increased from 2012 to 2019, with an associated annual change of 2.5% (95% CI, 1.8–3.3). Men, older adults (aged ≥85 years), and non‐Hispanic Black or African American individuals had higher mortality rates than women, younger individuals, and other racial and ethnic individuals, respectively. Despite lower AAMRs throughout the study period, women experienced greater increases in AAMR from 2012 to 2019 compared with men. Similarly, non‐Hispanic Black or African American individuals had a pronounced increase in AAMR from 2012 to 2019. Conclusions Despite an initial decline in AoD mortality, the mortality rate has been increasing from 2012 to 2019, with pronounced increases among women and non‐Hispanic Black or African American individuals.

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Section: Discussionmentioning

confidence: 99%

Demographic and Regional Trends of Mortality in Patients With Aortic Dissection in the United States, 1999 to 2019

Nazir

Ariss

Minhas

et al. 2022

JAHA

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“…A recent meta□analysis enrolled 8 cohort studies with a total of 2,818 cases and 4,563,501 participants to investigate the association between hypertension & blood pressure elevation and aortic dissection (AD). (1) These findings were of great interest as discussed below. The summary relative risks (RRs) for hypertension were 3.07 (95% CI 2.15-4.38, I 2 =76.7%).…”

mentioning

confidence: 86%

“…Based on this, our MR study proved the positive causality between hypertension, DBP and AD which were consistent with present epidemiological evidence. (1) However, the conclusion of causal relationship between SBP and AD was not supported by existing literature. The different roles for SBP & DBP were also observed in other cardiovascular disease awaiting further investigation.…”

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confidence: 90%

Research Letter: Genetically determined blood pressure traits are associated with increased risk of aortic dissection: a Mendelian randomization study

Lin

Zheng

2022

Preprint

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Objective: To identify blood pressure traits influencing aortic dissection susceptibility using Mendelian randomization (MR). Methods: Summary statistics of AD genome-wide association studies (GWAS) was obtained from FinnGen R5 release, which included 470 individuals with AD and 206541 controls. Firstly, inverse variance weighted (IVW) was used to calculate the overall OR for blood pressure traits. Further, directional pleiotropy and heterogeneity were tested as well as MR pleiotropy residual sum and outlier (MR-PRESSO) method. Results: Positive associations were observed between DBP (OR=1.13, 95%CI 1.09-1.18, P-adjusted < 0.001), hypertension (OR=9.71, 95%CI 2.45-38.25, P-adjusted = 0.006) and AD. Further, there was potential causal relationship between MAP and AD (OR=1.15, 95%CI 1.02-1.30, P-unadjusted = 0.020). No significant association between SBP or PP and AD in the European populations were observed. No directional pleiotropy was observed. Heterogeneity was only detected in the genetic instruments for SBP (Cochran Q statistics = 491.7, P = 0.010). The MR-PRESSO suggested one outlier SNP for SBP and one for PP which did not affect the result above. Conclusion: In this study, we identified a forward causation between hypertension, SBP and AD. In addition, there were nominal significant causations between MAP and AD. No significant causal relationships were detected between other investigated blood pressure traits (SBP, PP) and AD.

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“…Therefore, it is critical to identify high-risk subjects and prevent the development of AD in apparently healthy individuals during health check-ups. Aging, hypertension, and connective tissue diseases, which induce medial degeneration, are antecedent risk factors for AD [7][8][9][10][11] . Recently, obesity has gained attention in the field of aortic aneurysm development 12) .…”

Section: Introductionmentioning

confidence: 99%

A Body Shape Index and Aortic Disease-Related Mortality in Japanese General Population

Otaki

Watanabe

Konta

et al. 2023

JAT

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Aims: Aortic diseases (ADs), including aortic dissection, aortic aneurysm, and aortic rupture, are fatal, with extremely high mortality rates. A body shape index (ABSI), an anthropometric measure calculated as waist circumference adjusted by height and weight, improves the predictive capacity for mortality. However, whether ABSI is a risk factor for AD-related mortality in the general population remains unclear. Methods: We used a nationwide database of 630,842 individuals (aged 40-75 years) who participated in the annual "Specific Health Check and Guidance in Japan" between 2008 and 2010. Results: During the follow-up period of 3.8 years, 159 AD-related deaths occurred, including 105 aortic dissections and 54 aortic aneurysm ruptures. The subjects were divided into three groups based on ABSI tertiles. Kaplan-Meier analysis demonstrated that the 3 rd tertile (with the highest ABSI) had the greatest risk among the three groups. Multivariate Cox proportional hazard regression analysis demonstrated that ABSI was significantly associated with AD-related death after adjusting for confounding risk factors. Neither waist circumference nor body mass index consistently predicted AD-related death in the multivariate model. The prediction capacity was significantly improved by the addition of ABSI to the confounding risk factors. Conclusions: We demonstrated for the first time that ABSI, a surrogate marker for abdominal visceral fat tissue, was associated with AD-related deaths in the general population, suggesting the importance of central adiposity in the development of AD.

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Blood Pressure, Hypertension, and the Risk of Aortic Dissection Incidence and Mortality: Results From the J-SCH Study, the UK Biobank Study, and a Meta-Analysis of Cohort Studies

Cited by 73 publications

References 39 publications

Demographic and Regional Trends of Mortality in Patients With Aortic Dissection in the United States, 1999 to 2019

Demographic and Regional Trends of Mortality in Patients With Aortic Dissection in the United States, 1999 to 2019

Research Letter: Genetically determined blood pressure traits are associated with increased risk of aortic dissection: a Mendelian randomization study

A Body Shape Index and Aortic Disease-Related Mortality in Japanese General Population

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