From the Guidelines
A person with atherosclerosis of the thoracic aorta can live with the condition for decades, but life expectancy depends on the severity, complications, and management of the disease, with proper treatment and management, many patients can live a normal lifespan. The condition typically develops slowly over decades, beginning in early adulthood and progressing with age. Serious complications like aortic aneurysm, dissection, or rupture can significantly reduce life expectancy if they occur. According to the 2022 ACC/AHA guideline for the diagnosis and management of aortic disease 1, atherosclerotic aortic aneurysms increase the risk of stroke and myocardial infarction, and thus are considered a coronary artery disease equivalent.
The progression rate varies widely between individuals based on risk factors including:
- Hypertension
- Diabetes
- Smoking
- High cholesterol
- Obesity
- Genetic predisposition Regular medical follow-up with imaging studies (ultrasound, CT, or MRI) is essential to monitor disease progression and detect complications early, as recommended by the ACR Appropriateness Criteria for suspected acute aortic syndrome 1. Advanced cases may require surgical intervention such as endovascular repair or open surgery, which carry their own risks but can be life-saving for severe disease.
Medication management, including statins, antihypertensives, and antiplatelet drugs, is crucial in managing the condition, with statins potentially reducing the rate of aortic dilation and improving survival, as suggested by the Cholesterol Treatment Trialists’ Collaboration 1. Lifestyle modifications, such as smoking cessation, healthy diet, and regular exercise, are also essential in managing the condition and reducing the risk of complications.
Overall, with proper treatment and management, many patients with atherosclerosis of the thoracic aorta can live a normal lifespan, but it is essential to closely monitor the condition and adjust treatment as needed to prevent complications and reduce the risk of mortality.
From the Research
Atherosclerosis of the Thoracic Aorta
- Atherosclerosis of the thoracic aorta is a significant predictor of long-term neurologic events and mortality 2
- The severity of atherosclerosis is directly related to the incidence of neurologic events and mortality, with a greater than threefold increase in the incidence of both as the severity of atherosclerosis increases from normal-mild to severe 2
- Aortic atheromas are found in about one quarter of patients presenting with embolic events, and their grading by transesophageal echocardiography (TEE) correlates with the risk of future embolism 3
- Protruding atherosclerotic lesions in the thoracic aorta, often with superimposed mobile thrombi, are an important cause of embolic disease 4
Treatment and Prognosis
- Treatment with statins has been associated with a significant reduction in mortality and slowed progression to aortic stenosis in patients with aortic sclerosis 5
- Anticoagulation may help prevent emboli in patients with atherosclerotic lesions in the thoracic aorta 4
- Oral anticoagulants have been shown to be more effective than antiplatelets in reducing embolic events and combined events in patients with aortic plaques >4 mm thick 6
- Patients with aortic debris have a higher mortality rate and may benefit from oral anticoagulants 6
Risk Factors
- Hypertension, diabetes mellitus, and advanced age are independent predictors of long-term neurologic events and mortality in patients with atherosclerosis of the thoracic aorta 2
- Left ventricular dysfunction and carotid artery disease are also significant risk factors for mortality and neurologic events 2