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Original research
Longitudinal changes of thoracic aortic diameters in the general population aged 55 years or older
  1. Carlijn G E Thijssen1,2,
  2. Ferit O Mutluer1,3,
  3. Janine E van der Toorn4,5,
  4. Lidia R Bons1,
  5. Arjen L Gökalp6,
  6. Johanna JM Takkenberg6,
  7. Mostafa M Mokhles6,7,
  8. Roland R J van Kimmenade1,2,
  9. Meike W Vernooij4,5,
  10. Aad van der Lugt4,
  11. Ricardo P J Budde4,
  12. Jolien W Roos-Hesselink1,
  13. Maryam Kavousi5,
  14. Daniel Bos4,5
  1. 1 Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
  2. 2 Cardiology, Radboudumc, Nijmegen, The Netherlands
  3. 3 Department of Cardiology, Yeditepe Üniversity Hospital, Istanbul, Turkey
  4. 4 Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
  5. 5 Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
  6. 6 Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
  7. 7 Cardiothoracic Surgery, UMC Utrecht, Utrecht, The Netherlands
  1. Correspondence to Dr Jolien W Roos-Hesselink, Department of Cardiology, Erasmus MC, 3000 CA Rotterdam, The Netherlands; j.roos{at}


Objective Longitudinal data on age-related changes in the diameters of the thoracic aorta are scarce. To better understand normal variation and to identify factors influencing this process, we aimed to report male-female-specific and age-specific aortic growth rate in the ageing general population and identify factors associated with growth rate.

Methods From the prospective population-based Rotterdam Study, 943 participants (52.0% females, median age at baseline 65 years (62–68)) underwent serial non-enhanced cardiac CT. We measured the diameters of the ascending (AA) and descending aorta (DA) at two time points and expressed absolute and relative differences. Linear mixed effects analysis was performed to identify determinants associated with change in aortic diameters.

Results Mean AA diameter at baseline was 37.3±3.6 mm in male population and 34.7±3.2 mm in female population, mean DA diameter was 29.6±2.3 in male population and 26.9±2.2 mm in female population. The median absolute change in diameters during follow-up (mean scan interval 14.1±0.3 years) was 1 mm (0–2) for both the AA and DA. Absolute change per decade in AA diameter was significantly larger in males than in females (0.72 mm/decade (0.00–1.43) vs 0.70 mm/decade (0.00–1.41), p=0.006), as well as absolute change in AD diameter (0.71 mm/decade (0.00–1.42) vs 0.69 mm/decade (0.00–1.36), p=0.008). There was no significant difference between male and female population in relative change of their aortic diameters during follow-up. Age, male sex, higher body mass index (BMI) and higher diastolic blood pressure (DBP) showed a statistically significant independent association with increase in AA and DA diameters over time.

Conclusions Some degree of increase in thoracic aortic diameters is typical in both men and women of an aging population. Factors associated with this change in thoracic aortic diameters were sex, age, BMI and DBP.

  • epidemiology
  • aortic aneurysm
  • multidetector computed tomography

Data availability statement

Data are available upon reasonable request. The data underlying this article were provided by the Rotterdam study by permission. Data will be shared on request to the corresponding author with permission of the Rotterdam Study research group.

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Data availability statement

Data are available upon reasonable request. The data underlying this article were provided by the Rotterdam study by permission. Data will be shared on request to the corresponding author with permission of the Rotterdam Study research group.

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  • JWR-H, MK and DB contributed equally.

  • Contributors CGET provided substantial contributions to the conception, design, data collection, data analysis, interpretation of the data and preparation of the manuscript. JWR-H (guarantor) and DB supervised this project from its conception, including the study design, data analysis and interpretation and manuscript preparation. These authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MK co-supervised the projects' data analysis and interpretation, and manuscript preparation. FOM, LRB, JEvdT, ALG, MMM, RRLvK, JJMT, MV, AvdL and RB provided substantial contributions to the conception, design and drafting of this work, aided in revising the work critically for important intellectual content, and provided final approval of the version to be published. All authors consented to the submission of this manuscript.

  • Funding The Rotterdam Study is funded by Erasmus MC and Erasmus University, Rotterdam, the Netherlands; the Netherlands Organisation for Scientific Research (NWO); the Netherlands Organisation for Health Research and Development (ZonMw); the Research Institute for Diseases in the Elderly (RIDE); the Ministry of Education, Culture and Science; the Ministry for Health, Welfare and Sports; the European Commission (DG XII) and the Municipality of Rotterdam. MK is supported by a VENI grant from ZonMw (91616079). JWR-H, LRB, CGET, ALG, MMM and JJMT are supported by the Dutch Heart Foundation (2013T093) and ZonMW (849200014).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.