Population-Based Study of Incidence and Outcome of Acute Aortic Dissection and Pre-Morbid Risk-Factor Control: 10-Year Results From the Oxford Vascular Study

Study Questions:

What are epidemiologic features and risk factors associated with acute aortic dissection in a prospective population-based study of acute aortic disease?


The Oxford Vascular Study (OXVASC) was a prospective study of all acute aortic dissections in a population of 92,728 individuals in Oxfordshire, United Kingdom, during 2002-2012. Case ascertainment was by prospective daily searches for acute events and retrospective searches of hospital and primary care administrative and diagnostic coding data.


Of 52 incident dissections, 37 (71.2%) were Stanford type A and 15 (28.8%) were type B. The 30-day fatality rate was 47.4% for type A cases who survived to hospital admission and 13.3% for type B cases, although subsequent 5-year survival rates were high (85.7% for type A; 83.3% for type B). Hypertension (67.3%) was the most prevalent risk factor, followed by having ever smoked (61.5%). Premorbid control of blood pressure was poor despite 67.3% of patients being on antihypertensive medication. Over the 5 years prior to the incident dissection, the proportion of all blood pressures recorded in primary care in individual patients that were greater than 140/90 mm Hg averaged 56.0%.


The population-based OXVASC study demonstrated incidence and case-fatality rates of acute aortic events that are greater than those observed in hospital-based registries, and confirmed that uncontrolled hypertension remains the most treatable risk factor for acute aortic dissection.


In a novel population-based study of acute aortic events, the authors have overcome select limitations of existing hospital-based studies and retrospective registry data. By potentially including deaths prior to hospital admission, the authors have highlighted an incidence of acute dissection higher than previously estimated. The authors also confirmed the strong association between hypertension and aortic dissection, and have created a call to action for primary prevention and aggressive management of hypertension and smoking cessation. Hypertension remains the most modifiable risk factor for acute aortic dissection, and is frequently poorly controlled prior to an incident dissection. This is an opportunity for primary prevention.

Clinical Topics: Prevention, Hypertension

Keywords: Great Britain, Blood Pressure, Risk Factors, Primary Prevention, Registries, Incidence, Smoke, Primary Health Care, Smoking Cessation, Hypertension

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