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(Circulation. 1997;96:2115-2117.)
© 1997 American Heart Association, Inc.
Articles |
Inflammation, Metalloproteinases, and Increased Proteolysis
An Emerging Pathophysiological Paradigm in Aortic Aneurysm
From the Atherosclerosis Research Center, Division of Cardiology, and the Burns and Allen Research Institute, Cedars-Sinai Medical Center and UCLA School of Medicine, Los Angeles, Calif.
Correspondence to P.K. Shah, MD, Room 5347, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048. E-mail shahp@csmc.edu
Key Words: Editorials • metalloproteinases
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Introduction |
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Abdominal aortic aneurysm is a common and potentially lethal disease with an estimated incidence of 20 to 40 cases per 100 000 persons per year.1 In the United States, nearly 45 000 operations are performed annually for AAA.2 Most aneurysms are clinically silent until the time of rupture. Elective surgical mortality for unruptured aneurysms varies from 2% to 7%, but mortality jumps to 50% to 70% when rupture occurs before surgery.2 Risk factors for the development of AAA include advancing age, male sex, chronic obstructive lung disease, cigarette smoking, hypertension, and genetic factors.2 One of the most important determinants of risk for rupture is the size of the aneurysm.2 The overall risk of rupture is 3% to 8% for aneurysms <4 cm in diameter, whereas rupture occurs in 20% to 40% of patients with an aneurysm diameter >5 cm.2 Aneurysms between 4 and 4.5 cm in diameter carry a 10% to 12% risk of rupture.2 Although there is a considerable variability in the rate of expansion, on average, expansion occurs in an exponential fashion with an
10% diameter
increase per year (0.3 to 0.6 cm/y for aneurysms 3 to 6 cm in
size).2 Expansion rate is reduced by ß-blockers and
enhanced in patients with uncontrolled diastolic
hypertension, smoking, and chronic obstructive lung
disease.3
Recent clinical and experimental studies have challenged the
long-held notion that AAA results primarily from a complication of
atherosclerosis.4 Although intimal
pathological lesions characterize occlusive atherosclerotic aortic
disease, one of the striking hallmarks of AAA is the
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