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Background: Triglyceride-glucose (TyG) index is an emerging surrogate indicator of insulin resistance, which has been demonstrated as a risk factor for various cardiovascular diseases including coronary syndrome, in-stent restenosis, and heart failure. However, association of TyG index with incident aortic dissection (AD) and aortic aneurysm (AA) remains to be investigated., Methods: This study included 420,292 participants without baseline AD/AA from the large-scale prospective UK Biobank cohort. The primary outcome was incident AD/AA, comprising AD and AA. Multivariable-adjusted Cox proportional hazards regression models and restricted cubic spline (RCS) analyses were applied to assess the relationship between TyG index and the onset of AD/AA. In addition, the association between TyG index and incident AD/AA was examined within subgroups defined by age, gender, smoking status, drinking status, diabetes, hypertension, and BMI., Results: Over a median follow-up period of 14.8 (14.1, 15.5) years, 3,481 AD/AA cases occurred. The incidence of AD/AA rose along with elevated TyG index. RCS curves showed a linear trend of TyG index with risk of incident AD/AA. TyG index was positively associated with risk of incident AD/AA after adjusting for age, gender, smoking status, drinking status, BMI, hypertension, LDL-c, and HbA1c, with adjusted HRs of 1.0 (reference), 1.20 (95% CI 1.08-1.35), 1.21 (95% CI 1.08-1.35), and 1.30 (95% CI 1.16-1.45) for TyG index quartiles 2, 3, and 4, respectively. Especially, participants in the highest TyG index quartile had highest risk of developing AA, with an adjusted HR of 1.35 (95% CI 1.20-1.52)., Conclusions: TyG index is independently associated with a higher risk of incident AD/AA, indicating the importance of using TyG index for risk assessment of AD/AA, especially for AA., (© 2024. The Author(s).)

We aimed to evaluate the association between air pollutants and mortality risk in patients with acute aortic dissection (AAD) in a longitudinal cohort and to explore the potential mechanisms of adverse prognosis induced by fine particulate matter (PM2.5). Air pollutants data, including PM2.5, PM10.0, nitrogen dioxide (NO 2 ), carbon monoxide (CO), sulfur dioxide (SO 2 ), and ozone (O 3 ), were collected from official monitoring stations, and multivariable Cox regression models were applied. Single-cell sequencing and proteomics of aortic tissue were conducted to explore the potential mechanisms. In total, 1,267 patients with AAD were included. Exposure to higher concentrations of air pollutants was independently associated with an increased mortality risk. The high-PM2.5 group carried approximately 2 times increased mortality risk. There were linear associations of PM10, NO 2 , CO, and SO 2 exposures with long-term mortality risk. Single-cell sequencing revealed an increase in mast cells in aortic tissue in the high-PM2.5 exposure group. Enrichment analysis of the differentially expressed genes identified the inflammatory response as one of the main pathways, with IL-17 and TNF signaling pathways being among the top pathways. Analysis of proteomics also identified these pathways. This study suggests that exposure to higher PM2.5, PM10, NO 2 , CO, and SO 2 are associated with increased mortality risk in patients with AAD. PM2.5-related activation and degranulation of mast cells may be involved in this process.

Background: Dyslipidemia and local inflammation at sites of lipid deposition on blood vessel walls have been demonstrated to be risk factors for patients with acute aortic dissection (AAD). Statins have anti-inflammatory and lipid-lowering effects, which suggest that statins may play an important role in the prevention and treatment of AAD. Some retrospective studies show that statins can protect patients with aortic dissection. However, the effect of statins on the survival of AAD patients has been scarcely investigated, especially in randomized trials. In this study, we will perform a randomized clinical trial to understand whether statins can reduce in-hospital mortality of AAD patients., Methods: A total of 384 subjects diagnosed with AAD in the First Affiliated Hospital of Shantou University Medical College will be recruited. Participants will be randomly divided into an atorvastatin-treated or control group. The primary outcome will be the in-hospital mortality at 30 days., Discussion: This study is designed to verify the efficacy of atorvastatin on reducing in-hospital mortality of patients with AAD. The aim is to provide a new means of improving survival as a complement to conventional drug therapy., Trial Registration: Chinese Clinical Trials Registry ChiCTR1900023515 . Registered on 1 June 2019.

Background: The association between different ABO blood groups and mortality of aortic dissection (AD) remains controversial. This study aimed to examine whether different ABO blood groups affect the prognosis of AD., Methods: Demographic and clinical data were collected from 877 patients diagnosed with AD from 2015 to 2019 in the First Affiliated Hospital of Shantou University Medical College. The association between in-hospital mortality of AD patients and ABO blood group was analyzed using Cox proportional hazards regression models., Results: This retrograde cohort study demonstrated that for 877 patients, male gender, non-O blood group, Stanford type B AD (TBAD), higher presenting systolic and diastolic blood pressure, and being a recipient of aortic arch replacement surgery (surgery) or endovascular stent-graft implantation (stent-graft) were associated with decreased in-hospital mortality of AD. In Cox proportional hazards models, non-O blood group was associated with lower risk of early mortality regardless of adjustment (HR = 0.668, 95% confidence interval [CI] 0.473-0.944 before adjustment, HR = 0.662, 95% CI 0.468-0.935 after adjustment for age and sex, and HR = 0.641, 95% CI 0.453-0.906 after adjustment for AD types, SBP and surgery). Further analyses revealed that for patients diagnosed with type A AD (TAAD), non-O blood group renders a significant 34.3% decrease in the risk of in-hospital mortality compared with blood group O. Specifically, this difference in mortality risk was found among TAAD patients who did not undergo surgery (HR = 0.579, 95% CI 0.377-0.889), rather than those who did. There was no significant difference in early mortality for patients with TBAD, whether or not stent-grafts were implanted., Conclusions: Non-O blood type decreases the risk of in-hospital mortality, especially for TAAD, in AD patients without surgical intervention. More attention must be paid to blood type O TAAD patients without surgical interventions, and early surgical intervention may be an effective means to decrease in-hospital mortality of TAAD.

Background: Hypertension is the most important risk factor for aortic dissection. We aimed to assess the association of systolic blood pressure (SBP) and diastolic blood pressure (DBP) at admission with aortic-related adverse events (ARAE) after thoracic endovascular aortic repair (TEVAR)., Methods: All patients (n = 269) admitted with type B aortic dissection (BAD) for TEVAR were included. ARAE at 3, 24, and 60 months were evaluated as outcomes. Cox proportional regression analysis was performed., Results: No variables were found to be predictors of 3-month ARAE by multiple analysis. Independent predictors of 24-month ARAE were DBP at admission (hazard ratio [HR] per 10 mm Hg decrement, 1.318; 95% confidence interval [CI] 1.059-1.641; p = 0.013), cerebrovascular accident (HR 1.965; 95% CI 1.097-3.522; p = 0.023) and obesity (HR 2.922; 95% CI 1.096-7.795; p = 0.032). DBP at admission (HR per 10 mm Hg decrement, 1.276; 95% CI 1.038-1.569; p = 0.021) was also a predictor of 60-month ARAE. In the non-chronic group (n = 223), DBP at admission was evaluated as an independent predictor of 3-month (HR per 10 mm Hg decrement, 1.809; 95% CI 1.084-3.018; p = 0.023), 24-month (HR per 10 mm Hg decrement, 1.344; 95% CI 1.070-1.688; p = 0.011) and 60-month (HR per 10 mm Hg decrement, 1.338; 95% CI 1.065-1.682; p = 0.013) ARAE. In the chronic group (n = 46), no variables were found to be independent predictors of 3-month, 24-month, or 60-month ARAE., Conclusions: DBP at admission can predict ARAE in patients with BAD after TEVAR, whereas SBP was not associated with ARAE. The relationship between DBP at admission and outcomes appears to be more prominent in non-chronic patients., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: The association of simple renal cyst (SRC) with type B aortic dissection (BAD) has recently been established. However, no studies have examined adverse events after BAD hospitalization among patients with SRC. In this study, we assessed the prognostic value of SRC in BAD patients with hypertension after thoracic endovascular aortic repair (TEVAR)., Methods: We studied all BAD patients with hypertension who were admitted for TEVAR (n = 238; age 56.1 ± 9.8 years, 84.0% male). Aortic-related adverse events (ARAE) were evaluated as outcomes at 3 months and 24 months after TEVAR., Results: Among the total number of patients, 104 (43.7%) had at least 1 SRC. Patients with SRC were significantly older than those without (59.6 ± 8.8 vs 53.3 ± 9.7; P < 0.001). Patients with SRC were also more likely to suffer from peripheral arterial disease (55.8% vs 40.3%; P = 0.018) and cerebrovascular accidents (47.1% vs 29.9%; P = 0.006) than those without. Median follow-up for the 238 patients was 18.5 (range 6.4-24.0) months. Cumulative ARAE-free rates were 94.5 ± 1.5% at the 3-month follow-up and 81.5 ± 2.8% at the 24-month follow-up. Independent predictors of 3-month ARAE were found to be insertion of ≥ 2 stents (hazard ratio [HR] 3.977, 95% confidence interval [CI] 1.224-12.920; P = 0.022). For 24-month follow-up, SRC (HR 1.962, 95% CI 1.023-3.764; P = 0.043) was evaluated as the only independent predictive factor. SRC (HR 8.841, 95% CI 1.726-45.294; P = 0.009) was also evaluated as an independent predictive factor for 24-month ARAEs in the chronic group, but not in the acute or the subacute group., Conclusions: SRC could predict 24-month ARAE in BAD patients with hypertension after TEVAR, especially in the chronic group., (Copyright © 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Background: Guidelines recommend tight systolic blood pressure (SBP) control for favorable outcomes of type B aortic dissection (BAD) but are still limited by the optimal cut-off value of SBP. The purpose of this study was to evaluate the optimal cut-off value of SBP in BAD patients after thoracic endovascular aortic repair (TEVAR)., Methods: From January 2011 to April 2017, 269 consecutive patients with BAD after TEVAR were included in the study. All patients were followed up according to a strict follow-up protocol. Cox regression analysis was used to examine the association between SBP at discharge and 90-day aortic related adverse events (ARAE)., Results: All 269 patients completed 90 days of follow-up, and the unadjusted ARAE-free rates at 90-day was 95.1 ± 1.3%. The cut-off value of SBP at discharge identified by receiver operator curve was 130 mmHg for 90-day ARAE. In multivariable models, binary SBP at discharge was significant associated with 90-day ARAE (HR 3.780; 95% CI 1.236-11.556; p = 0.020). Hybrid operation (OR 2.046; 95%CI 1.015-4.122; p = 0.045) and insertion of ≥2 stents (OR 2.950; 95%CI 1.172-7.426; p = 0.022) were demonstrated to be independently associated with poor SBP control (SBP > 130 mmHg) using Logistic analysis., Conclusions: The optimal cut-off value of SBP at discharge was 130 mmHg which can be used to predict short-term ARAE. Blood pressure in patients with hybrid operation and ≥ 2 stents should be given more focus.

Background: Aortic dissection (AD) is a lethal cardiovascular emergency involving high mortality and disability. However, its specific pathogenesis remains to be elucidated. Methods: A bibliometric analysis based on the Web of Science database, VOSviewer software and Citex platforms was conducted to have a knowledge of the development trends, frontiers and hot spots of AD. Subsequently, the top five AD‐related genes from the titles and abstracts of published literature were searched. Lastly, the roles of the top five genes and their encoded proteins in the onset of AD were reviewed. Results: The bibliometrics showed that most studies are exploring the molecular drivers related to AD, especially gene mutations. The top five AD‐related genes were transforming growth factor‐β (TGFB)‐related genes, elastin (ELN), fibrillin‐1 (FBN1), angiotensinogen (AGT) and matrix metalloproteinase 9 (MMP9). In particular, regulation of the structure of elastic fiber by TGFB‐related genes, ELN and FBN1, appears to be the principal mechanism contributing to AD onset. Activation of the renin‐angiotensin system is the principal mechanism by which AGT triggers AD. MMP9 promotes the formation and development of AD by degrading extracellular matrix components. Conclusion: TGFB, ELN, FBN1, AGT and MMP9 are the five top molecular drivers of AD, providing a comprehensive mechanistic insight into AD. [ABSTRACT FROM AUTHOR]