Circulation. 1998;98:193-195
(Circulation. 1998;98:193-195.)
© 1998 American Heart Association, Inc.
Aortic Aneurysm Formation
Lessons From Human Studies and Experimental Models
M.J. Davies, MD, FRCP, FRCPath, FECC
From St George's Hospital Medical School, BHF Cardiovascular
Pathology Unit, Histopathology Department, London, UK.
Correspondence to Dr M.J. Davies, St George's Hospital Medical School, BHF Cardiovascular Pathology Unit, Histopathology Department, Cranmer Terrace, London SW17 ORE, UK.
Key Words: Editorials • aneurysm • aorta
The development of a
saccular (nondissecting) aortic aneurysm follows the
destruction of the connective tissue in the media, in particular the
elastic lamellae. The vessel wall is then unable to withstand the
expansile force of each systolic contraction. The current view
is that the great majority of aortic aneurysms, >90% of which
are below the renal arteries, are associated with
atherosclerosis.1 This view is
based on the fact that the lower abdominal aorta is the site at which
atherosclerosis first develops and confluent intimal
involvement becomes common by middle age. Resected abdominal aortic
aneurysms show advanced atherosclerosis with
mural thrombus in the wall. This view, however, is a paradox in that
atherosclerosis is an intimal disease, whereas in the
abdominal aorta, aneurysms are due to major medial damage.
There are also other reasons to believe that aortic aneurysms
have an additional component to their pathogenesis. Abdominal aortic
aneurysms are familial and under genetic influences unrelated
to lipid-related risk factors for atherosclerosis.
First-degree relatives of index cases with abdominal aortic
aneurysms have a significantly higher risk of developing a
similar lesion when compared with the general population. Prospective
family studies suggest a figure of 14.5% for offspring and 13% to
32% for siblings compared with the general population risk of 2% to
5%.2 3 4 Risk factors such as elevated plasma
cholesterol,
hypertriglyceridemia, hypertension, and
smoking are found in many subjects with abdominal aortic
aneurysms, yet 60% of cases have plasma
cholesterol levels of <240 mg/dL.1
Smoking is the single largest external contributor . . . [Full Text of this Article]
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