Acute Aortic Disease.. - Index of

Epidemiology: Incidence, Prevalence, and Trends 95
TRENDS
There is little doubt that the diagnosis of aortic aneurysm and its acute complications
are being made with greater frequency. The Swedish group found a
doubling in the rate of ruptured AAA over several decades (7). The Mayo group
found a tripling in the diagnosis of thoracic aortic aneurysm over 15 years (8).
This trend toward increased incidence of aneurysm disease over the last
three decades has been confirmed also for the United States as a whole by the
Centers for Disease Control (14), for Scotland (15), for the Netherlands (16), and
for England and Wales (17).
So, the diseases of interest to this book are definitely being diagnosed more
frequently than ever before.
It is unclear how much of this increased incidence is due to several important
factors:
Improved Diagnosis in This Era of Common Application of
Three-Dimensional Imaging (Computed Tomography Scan,
Magnetic Resonance Imaging, and Echocardiography)
This seems quite likely an important factor in the increased incidence, as so many
of our aneurysm patients have the first diagnosis made on a 3D image done for
entirely unrelated reasons.
The Aging of Our Population
This is certainly an important factor, as aneurysm disease increases with age.
True Increase in Disease Incidence, Independent of Diagnosis
and Population Age
This possibility is intriguing. Best et al. feel that, in addition to improved diagnosis
of existing cases and aging of the population, a “genuine and persistent rise in the
incidence of AAA has probably occurred” (15). They find this increase especially
interesting in terms of its contrast with the general decrease in arteriosclerotic
vascular disease realized through the vigorous preventive efforts of the last several
decades. If we are living in an era of true increase in the incidence of aneurysm
disease, the relevant causes are obscure.
Genetics
There is an important observation regarding the impact of genetic syndromes on
the epidemiology of thoracic aortic aneurysms. This concerns the relative contributions
of Marfan’s disease and bicuspid aortic valve disease to the incidence of
aortic aneurysm.
Marfan’s disease is more widely recognized as a cause of aneurysm and
dissection. Nonetheless, Marfan’s disease is relatively uncommon, affecting only
1 in 10,000 live births. A patient with Marfan’s disease has a 40% likelihood over
a lifetime of developing an aortic dissection.