Aortic dissection risk factors: who is more likely

What an aortic dissection is

The aorta is the main artery that runs from the heart through the chest and abdomen (MedlinePlus). In an aortic dissection, the inner layer of the aortic wall splits, and blood then enters between the inner and middle layers of the wall (NHLBI). MedlinePlus Genetics describes it as a sudden tearing of the layers in the aorta wall that lets blood flow abnormally between the layers. It can decrease blood flow to the brain or other vital organs, or cause the aorta to break open (rupture) (MedlinePlus Genetics).

Dissection is closely tied to aortic aneurysms. If an aortic aneurysm grows large, it can burst or tear the wall of the artery (dissection), and both can be life-threatening (NHLBI). MedlinePlus Genetics notes that in some people a dissection happens with little or no widening of the aorta first (MedlinePlus Genetics). Ruptured aortic aneurysms and dissections are estimated to cause almost 30,000 deaths in the United States each year (MedlinePlus Genetics).

This page is about the aorta. A bulge in the aorta in the belly is covered on abdominal aortic aneurysm risk factors, and a weak spot on a blood vessel in the brain is a different condition; see brain aneurysm risk factors.

What raises the risk of a tear

NHLBI names medical conditions that raise the risk of rupture or dissection of an aortic aneurysm: high blood pressure, coronary heart disease, chronic kidney disease and high blood cholesterol. Your provider may treat these to lower that risk (NHLBI).

For thoracic aortic aneurysms and dissections (in the chest), MedlinePlus Genetics says at least 20 percent run in families. In the rest, the cause is thought to be factors that are not inherited, such as damage to the walls of the aorta from aging, tobacco use, injury or disease (MedlinePlus Genetics).

Risk factors for aortic aneurysms in the chest

Because a large aortic aneurysm can tear the artery wall (NHLBI), the risk factors NHLBI lists for aortic aneurysms matter here too. These are the ones NHLBI ties to thoracic (chest) aortic aneurysms or to aortic aneurysms in general (NHLBI):

• High blood pressure. NHLBI calls it the leading risk factor for thoracic aortic aneurysms.
• Genetic and family conditions: Ehlers-Danlos syndrome, Loeys-Dietz syndrome, Marfan syndrome, Turner syndrome, familial thoracic aortic aneurysms and a bicuspid aortic valve (an abnormal aortic valve). See also aortic stenosis risk factors for more on the aortic valve.
• Trauma, such as from car accidents or falls.
• Bacterial infections.
• Age. The risk of aortic aneurysms goes up as you age.
• Smoking. Cigarette smoking is one of the main factors that raises the risk of an aortic aneurysm. See our quit smoking help check.
• Stimulants such as cocaine, which raise blood pressure and the risk of an aortic aneurysm.
• Other medical conditions NHLBI lists for aortic aneurysms: aneurysms in other blood vessels, COPD, atherosclerosis, coronary heart disease, peripheral artery disease, unhealthy cholesterol, kidney conditions, obesity, pheochromocytoma (a rare adrenal tumor that can lead to high blood pressure) and vasculitis.
• Sex. Men are more likely than women to develop aortic aneurysms, but an existing aneurysm is more likely to rupture at a smaller size in women.

MedlinePlus also lists smoking, high blood pressure, high cholesterol and a family history of aneurysms as factors that may increase the risk of an aortic aneurysm (MedlinePlus).

When it runs in families

Familial thoracic aortic aneurysm and dissection (familial TAAD) is inherited in an autosomal dominant pattern: one copy of an altered gene can be enough to cause it, and in most cases an affected person has one affected parent. Some people who inherit the altered gene never develop the aortic problems (MedlinePlus Genetics). The aortic problems can begin in childhood or not until late in life, and their timing varies even within the same family (MedlinePlus Genetics).

Some people in affected families have mild features of Marfan syndrome or Loeys-Dietz syndrome, such as tall stature, stretch marks, very flexible joints and a sunken or protruding chest (MedlinePlus Genetics).

Symptoms

MedlinePlus Genetics says aortic dissections usually cause severe, sudden chest or back pain, and may also cause unusually pale skin, a very faint pulse, numbness or tingling in one or more limbs, or paralysis (MedlinePlus Genetics). NHLBI lists light-headedness, a rapid heart rate and sudden, severe pain in the stomach area, chest or back as symptoms of a rupture (NHLBI).

An aortic aneurysm may not cause any symptoms. When it does, NHLBI lists signs such as trouble swallowing, hoarseness, shortness of breath, and pain in the neck, jaw, back, chest, stomach area or shoulder (NHLBI).

Treatment and lowering the risk

For a known aneurysm, the goal of treatment is to slow its growth and lower the chance of rupture or dissection. NHLBI says quitting smoking is the most important part of treatment to slow the growth of the aneurysm. Large aneurysms may need surgery, and a rupture or dissection may require emergency surgery (NHLBI). NHLBI also advises heart-healthy eating, managing stress and avoiding stimulants such as cocaine for people with risk factors (NHLBI).

Common questions

Is an aortic dissection the same as an aortic aneurysm?

No. An aneurysm is a balloon-like bulge in the wall of an artery. If it grows large it can burst (rupture) or cause a tear in the artery wall (dissection) (MedlinePlus). A dissection can also happen with little or no widening of the aorta (MedlinePlus Genetics).

Does aortic dissection run in families?

It can. Familial TAAD is believed to account for at least 20 percent of thoracic aortic aneurysms and dissections (MedlinePlus Genetics), and NHLBI lists Marfan, Loeys-Dietz, Ehlers-Danlos and Turner syndromes and a bicuspid aortic valve as risk factors for thoracic aortic aneurysms (NHLBI).

What is the biggest risk factor?

NHLBI calls high blood pressure the leading risk factor for thoracic aortic aneurysms (NHLBI), and lists it among the conditions that raise the risk of rupture or dissection (NHLBI).