• Saadia Qazi, Joseph M Massaro, Michael L Chuang, Ralph B D'Agostino, Udo Hoffmann, and Christopher J O'Donnell.
• From the National Heart, Lung and Blood Institute's Framingham Heart Study, MA (S.Q., J.M.M., M.L.C., R.B.D., U.H., C.J.O.); Department of Biostatistics, Boston University School of Public Health, MA (J.M.M., R.B.D.); Cardiovascular Imaging Core Laboratory, Beth Israel Deaconess Medical Center, Boston, MA (M.L.C.); Cardiac MR PET CT Program and Department of Radiology, Massachusetts General Hospital, Boston (U.H.); Cardiology Section, Boston Veteran's Administration Healthcare, MA (S.Q., C.J.O.); Division of Aging, Brigham and Women's Hospital, Boston, MA (S.Q.); and Harvard Medical School, Boston, MA (S.Q., U.H., C.J.O.).
• Circ Cardiovasc Imaging. 2017 Dec 1; 10 (12).

BackgroundAdverse aortic remodeling, such as dilation, is associated with multiple cardiovascular disease (CVD) risk factors. We sought to determine whether measures of enlarged aortic diameters improve prediction of incident adverse CVD events above standard CVD risk factors in a community-dwelling cohort.Methods And ResultsParticipants from the Framingham Offspring and Third Generation Cohorts (n=3318; aged 48.9±10.3 years), who underwent noncontrast thoracic and abdominal multidetector computed tomography during 2002 to 2005, had complete risk factor profiles, and were free of clinical CVD, were included in this study. Diameters were measured at 4 anatomically defined locations: the ascending thoracic aorta, descending thoracic aorta, the infrarenal abdominal aorta, and lower abdominal aorta. Adverse events comprised CVD death, myocardial infarction, coronary insufficiency, index admission for heart failure, and stroke. Each aortic segment was dichotomized as enlarged (diameter ≥upper 90th percentile for age, sex, and body surface area) or not enlarged; the hazard of an adverse event for an enlarged segment was determined using multivariable-adjusted Cox proportional hazards models. Over a mean 8.8±2.0 years of follow-up, there were 177 incident adverse CVD events. In models adjusted for traditional CVD risk factors, enlarged infrarenal abdominal aorta (hazard ratio=1.57; 95% confidence interval=1.06 to 2.32) and lower abdominal aorta (hazard ratio=1.53; 95% confidence interval=1.00 to 2.34) were associated with an increased hazard of CVD events. Enlarged ascending thoracic aorta and descending thoracic aorta were not significantly associated with CVD events.ConclusionsAmong community-dwelling adults initially free of clinical CVD, enlarged infrarenal abdominal aorta and lower abdominal aorta, on noncontrast multidetector computed tomography scans, are independent predictors of incident adverse CVD events above traditional risk factors alone.© 2017 American Heart Association, Inc.

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