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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2004;24:1278.)
© 2004 American Heart Association, Inc.

Atherosclerosis and Lipoproteins

Infrarenal Aortic Diameter Predicts All-Cause Mortality

Paul Norman; Max Le; Carole Pearce; Konrad Jamrozik

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.

Correspondence to Paul Norman, University Department of Surgery, Fremantle Hospital, PO Box 480, Fremantle, Western Australia 6959. 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. Median diameter increased from 21.4 mm in the youngest men to 22.1 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.

Infrarenal aortic diameter was measured in 12 203 men. Cumulative mortality increased in a graded fashion with increasing aortic diameter. Using the interval 19 to 22 mm as the reference, the hazard ratio for all-cause mortality increased from 1.26 for aortic diameters of 23 to 26 mm to 2.38 for aortic diameters of 47 to 50 mm.

Key Words: aortic diameter • ultrasound • mortality

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