Winter and aortic dissection: Are you at risk?

February 28, 2022 5:00 AM

With winter in full swing, a cardiologist explains why some are at high risk of aortic dissection.

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Are you at risk for aortic dissection? Knowing the answer to this question could save your life, especially during the winter months. This is according to Marion Hofmann, M.D., a cardiologist at the University of Michigan Health Frankel Cardiovascular Center who specializes in aortic disease.

“Observational studies show that risk for aortic dissection is higher between the months of November and March,” said Hofmann. “This seasonal relationship is striking and doesn’t get enough attention.”

This is particularly true for individuals with an existing aortic aneurysm, a genetic predisposition for dissection (family history), hypertension and those over the age of 60.

Aortic dissection occurs when the wall of the aorta tears, allowing blood to enter through the tear and causing the aortic layers to separate or “dissect.” A tear that develops in the ascending aorta is known as a Type A dissection and is a life-threatening condition. In fact, acute Type A aortic dissection is the most feared complication in patients with a thoracic aortic aneurysm, Hofmann says.

What does the weather have to do with it?

“There are several studies that collectively show the risk for aortic dissection is higher during the winter months,” said Hofmann, who has conducted research at the University of Michigan Health Frankel CVC. “There are several possibilities for this, including an increase in upper respiratory infections such as influenza or higher blood pressure during winter months.” The reasons for increased blood pressure are unclear and may be related to less compliance with prescription refills and doctor visits, she notes.

Hofmann’s research looked at all Type A aortic dissection admissions to the University of Michigan Health and found a 31% increase during winter months from November through March, a finding supported by the International Registry of Acute Aortic Dissection. “Even in countries where the winters are not typically cold, there is an increase in aortic dissection. It isn’t the weather, per se, but the winter months when there tends to be more respiratory viruses.”

For example, she says, there is evidence that influenza can cause cardiovascular disease, including inflammation of the aorta. There are also more heart attacks, strokes and cardiovascular deaths overall during the winter months and specifically attributed to influenza, Hofmann notes.

When should you seek help?

Individuals at highest risk — those with an aortic aneurysm or a family history of aortic dissection — should seek immediate emergency medical treatment if they experience intense chest pain that radiates to the upper back.

“We see a very large group of patients with aneurysms, regardless of the size. Our goal is to reduce the risk for aortic dissection because once it occurs it is a life-threatening event,” Hofmann said. “But because patients with aortic aneurysms typically experience no symptoms, they may not be aware of their condition. Most aortic aneurysms are diagnosed incidentally during testing for another health issue.”

She also encourages individuals to be aware of their family history, as aortic dissections are often related to a genetic variance that causes the walls of the aorta to be weaker. “If there is a family history of dissection, all family members need to be screened.”

With the reality that only 30% of those who experience an aortic dissection make it to the emergency room in time, Hofmann wants people at risk to be aware of preventive measures they should take.

Preventive measures

“I tell my aortic disease patients that preventive measures are most important for them,” Hofmann said. These include embracing a heart healthy lifestyle: no smoking, controlled blood pressure, regular checkups, no heavy lifting or snow shoveling, safe exercising (biking, walking, isometrics) and preventive surgical treatments inpatients deemed at the highest risk for dissections.

She also advises her patients to get a yearly flu shot since there is an association of more cardiovascular disease in general during the flu season. “The flu shot helps prevent heart attacks in younger patients as well as the elderly. Studies also show that heart failure patients who receive a flu shot are less likely to be hospitalized for worsening symptoms.”

Finally, she urges patients to pay attention to symptoms and keep all scheduled appointments with their physicians. “Take advantage of all we can do,” she said.

Among the benefits offered at the Frankel Cardiovascular Center is the Cardiovascular Health Improvement Project (CHIP) study, which is a biorepository of DNA, plasma, serum and aortic tissue samples as well as an extensive clinical database of medical and family history information.

Hofmann says the goal of CHIP is to help cardiologists understand aortic-related diseases like aortic dissection.

“The study enables us to learn more about the genetic aspect of aortic disease and helps us identify those at risk so we can provide the best care for our patients.”

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