on May 6, 2004
Published online before print May 6, 2004, doi: 10.1161/01.ATV.0000131261.12051.7f
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Submitted on February 5, 2004
Accepted on March 19, 2004
Infrarenal Aortic Diameter Predicts All-Cause Mortality
Paul Norman *;
From the School of Surgery and Pathology (P.N.), The University of Western Australia, Fremantle Hospital, Fremantle, Western Australia; School of Population Health (M.L., C.P.), The University of Western Australia, Nedlands, Western Australia; and the Department of Primary Health Care and General Practice (K.J.), Imperial College London and Visiting Professor, School of Population Health, University of Western Australia.
* To whom correspondence should be addressed. E-mail: pnorman{at}cyllene.uwa.edu.au.
Objective--To assess the relationship between infrarenal aortic diameter and subsequent all-cause mortality in men aged 65 years or older.
Methods and Results--Aortic diameter was measured using ultrasound in 12 203 men aged 65 to 83 years as part of a trial of screening for abdominal aortic aneurysms. A range of cardiovascular risk factors was also documented. Mortality over the next 3 to 7 years was assessed using record linkage. Initial aortic diameter was categorized into 10 intervals, and the relationship between increasing diameter and subsequent mortality was explored using Cox proportional hazard models. Aortic diameter increased from 
22 mm in the youngest men to 24 mm in the oldest men. The cumulative all-cause mortality increased in a graded fashion with increasing aortic diameter. Using the diameter interval 19 to 22 mm as the reference, the adjusted hazard ratio for all-cause mortality increased from 1.26 (95% CI: 1.09, 1.44; P=0.001) for aortic diameters of 23 to 26 mm to 2.38 (95% CI: 1.22, 4.61; P=0.011) for aortic diameters of 47 to 50 mm. Analysis of causes of death indicated that cardiovascular disease was an important contributor to this increase.
Conclusion--Infrarenal aortic diameter is an independent marker of subsequent all-cause mortality.
Key words: aortic diameter • ultrasound • mortality
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