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  • Review Article
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Epidemiology of thoracic aortic dissection

Nature Reviews Cardiology volume 8, pages 103–113 (2011)Cite this article

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Abstract

Thoracic aortic dissection (TAD) is estimated to occur at a rate of 3–4 cases per 100,000 persons per year and is associated with a high mortality. Reported rates are probably underestimates of the true incidence of TAD because of difficulties in diagnosis. The incidence of TAD appears to have been increasing over time. TAD is most common in men and older individuals. Aortic dilatation is a well-established risk factor for TAD but is not a prerequisite; most ascending aortic dissections occur when aortic diameter is <5.5 cm. Although atherosclerosis and typical cardiovascular risk factors, such as hypertension and smoking, are associated with TAD, evidence supporting their direct causal role is lacking. Notably, diabetes mellitus is remarkably uncommon in patients with TAD. Other risk factors for TAD include inflammatory diseases, iatrogenic aortic injury, and drug use. Congenital cardiovascular defects, such as bicuspid aortic valve, and certain genetic syndromes, such as Marfan syndrome, are the genetic factors most commonly associated with TAD. Specific nonsyndromic genetic mutations in families and single nucleotide polymorphisms have also been identified as possible risk factors for TAD.

Key Points

  • The incidence of thoracic aortic dissection is probably underestimated (3–4 cases per 100,000 persons per year) and seems to be increasing, in part because of improvements in diagnostic imaging

  • Thoracic aortic dissection is a major cause of mortality in the general population, with rupture being the most common cause of death

  • Although aortic dilatation is a well-established risk factor for thoracic aortic dissection, most ascending aortic dissections occur when aortic diameter is <5.5 cm

  • Male sex and older age are risk factors for thoracic aortic dissection

  • Although atherosclerosis and typical cardiovascular risk factors are associated with thoracic aortic dissection, evidence supporting their direct causal role is lacking, and diabetes is remarkably uncommon in these patients

  • Congenital cardiovascular defects, such as bicuspid aortic valve, and genetic syndromes, such as Marfan syndrome, are the genetic factors most commonly associated with thoracic aortic dissection

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Figure 1: The anatomic extent of thoracic aortic dissection is classified according to the DeBakey system and the Stanford system.
Figure 2: Longitudinal sections of the aorta illustrating variants of acute aortic syndrome.

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Acknowledgements

The authors thank Stephen N. Palmer, PhD, ELS (Senior Scientific Medical Writer), and Marianne Mallia, ELS (Manager and Senior Medical Writer), of the Section of Scientific Publications at the Texas Heart Institute at St Luke's Episcopal Hospital, for invaluable editorial support. L. Russell is supported in part through the Biostatistics and Data Management Core of the Specialized Center of Clinically Oriented Research in Thoracic Aortic Aneurysms and Dissections (NIH P50 HL083794).

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  1. The Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, 77030, TX, USA

    Scott A. LeMaire & Ludivine Russell

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S. A. LeMaire and L. Russell both researched data for the article, contributed to the discussion of content, wrote the article, and revised/edited the article before submission and after peer review.

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Correspondence to Scott A. LeMaire.

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LeMaire, S., Russell, L. Epidemiology of thoracic aortic dissection. Nat Rev Cardiol 8, 103–113 (2011). https://doi.org/10.1038/nrcardio.2010.187

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