Abstract
Objective To shed light on the association between hyperhomocysteinemia (HHcy) and thoracoabdominal aortic aneurysms (TAAAs). Methods From July 2013 to March 2017, we conducted a matched case–control study involving individuals who presented to the Chinese People's Liberation Army General Hospital and underwent thoracoabdominal magnetic resonance angiography or computed tomography angiography. A total of 73 patients with TAAAs were enrolled in the case group, and 219 sex-matched subjects without TAAAs were included in the control group. We then examined the relationship between HHcy and TAAAs by logistic regression models and subgroup as well as interaction analyses. Results Serum total homocysteine (tHcy) concentrations and the proportion of HHcy were significantly higher in the patients with TAAAs than in those without TAAAs (P < 0.001). Furthermore, the multivariate logistic regression models indicated that participants with HHcy had a 2.14-fold higher risk of TAAAs than those with a normal serum tHcy level (adjusted odds ratio (OR), 2.14; 95% confidence interval, 1.00–4.56). Similarly, each 1 μmol/L increase in the serum tHcy concentration was associated with a 4% higher risk of TAAAs (adjusted OR, 1.04; 95% confidence interval, 1.00–1.07). Subgroup analyses indicated that HHcy tended to be associated with a greater risk of TAAAs in all stratified subgroups (adjusted ORs > 1). Furthermore, the interaction analyses revealed no interactive role in the association between HHcy and TAAAs. Conclusions The present case–control study suggests that HHcy is an independent risk factor for TAAAs. Larger prospective cohort studies are warranted to validate these findings.
Highlights
A thoracoabdominal aortic aneurysm (TAAA) is defined as a permanent and continuous dilatation of the descending thoracic aorta and abdominal aorta [1]
This paper describes the first case–control study to address the association between the serum total homocysteine (tHcy) level and risk of TAAAs
Our main finding is that an elevated serum tHcy level is independently associated with a higher risk of TAAAs
Summary
A thoracoabdominal aortic aneurysm (TAAA) is defined as a permanent and continuous dilatation of the descending thoracic aorta and abdominal aorta [1]. TAAAs reportedly have a low incidence of 5.9 cases per 100,000 inhabitants annually [2], surgical repair of TAAAs is associated with a perioperative mortality rate ranging from 7.5% to 46.1% [3, 4]. One study showed that the 5- and 10-year survival rates of patients with TAAAs undergoing open repair were 63.6% and 36.8%, respectively [3], indicating that the prognosis of patients with TAAAs is far from satisfactory. Many patients with TAAAs are asymptomatic, and these TAAAs may remain undiagnosticated for years [5]. Among patients with ruptured TAAAs who are able to undergo surgical repair, the operative mortality rate is reportedly as high as 46.1%, which is significantly higher than that of unruptured TAAA repair (15.9%) [4].
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