Chest x-ray aortic size and risk of death and cardiovascular disease in older Chinese: Guangzhou biobank cohort study

Background

Chest radiograph can independently predict adverse outcomes in outpatients. We examined the associations of aortic knob width (AKW), ascending aortic length (AAL), and ascending aortic width (AAW) from chest x-ray with death and cardiovascular events in adults aged 50 and above.

Methods

Participants without cardiovascular disease were included from the Guangzhou Biobank Cohort Study (2003–2008). AKW, AAL, and AAW were indexed by body surface area. Aortic enlargement was defined using sex- and age-specific thresholds, calculated as the average value plus 1.96 multiplied by the standard deviation (SD). The associations of AKW, AAL, and AAW indices with all-cause and cause-specific mortality (cardiovascular and cancer), and incident nonfatal and fatal cardiovascular events, were examined through multivariate Cox regressions. Logistic regressions were performed to determine risk factors for aortic enlargement.

Results

Among 27,047 participants (mean age 62 years ± 7 years SD), there were 6977 deaths and 6478 cardiovascular events over an average follow-up period of 16.3 years. Each SD increase in AKW index was associated with a higher risk of all-cause mortality, cardiovascular mortality, and cardiovascular events, with hazard ratios (95% confidence interval [CI]) of 1.13 (1.11–1.16), 1.20 (1.15–1.25), and 1.11 (1.08–1.14), respectively. Similar findings were observed regarding the AAL and AAW indices. Hypertension was a strong risk factor for enlarged AKW (odds ratio 2.52, 95% CI 2.17–2.93), AAL (1.95, 1.63–2.32), and AAW (1.80, 1.56–2.09), respectively.

Conclusions

Thoracic aortic parameters measured through an accessible, cheap, and safe chest radiograph were associated with higher risks of death and cardiovascular events. Hypertension should be managed.