Aortic Area as an Indicator of Subclinical Cardiovascular Disease

Allison L. Kuipers1, *, J. Jeffrey Carr2, James G. Terry2, Sangeeta Nair2, Emma Barinas-Mitchell1, Victor Wheeler3, Joseph M. Zmuda1, Iva Miljkovic1
1 Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
2 Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
3 Tobago Health Research Office, Ministry of Health, Scarborough, Tobago, Republic of Trinidad and Tobago

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© 2022 Kuipers et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh; 130 DeSoto Street, A543 Public Health, Pittsburgh, PA 15261, USA; Tel: 412-624-2781; Fax: 412-624-7397; E-mail:;



Outward arterial remodeling occurs early in cardiovascular disease (CVD) and, as such, measuring arterial dimension may be an early indicator of subclinical disease.


The objective of our study was to measure area at three aortic locations: The ascending thoracic (ASC), the descending thoracic (DSC), and the abdominal (ABD), and to test for association with traditional CVD risk factors and subclinical CVD throughout the body.


We measured ASC, DSC, and ABD using computed tomography (CT) in 408 African ancestry men aged 50-89 years. We assessed prevalent CVD risk factors via participant interview and clinical exam, and subclinical CVD, including carotid atherosclerosis through B-mode carotid ultrasound, vascular calcification via chest and abdominal CT, and arterial stiffness via pulse-wave velocity (PWV).


As expected, all aortic areas were in correlation with each other (r=0.39-0.63, all p<0.0001) and associated with greater age, greater body size, and hypertension (p≤0.01 for all). After adjustment for traditional CVD risk factors, ASC was positively associated with carotid atherosclerosis (p<0.01). A greater area at each location was associated with greater PWV (p<0.03 for all), with the DSC region showing the most significant association.


This is the first study to test the association of aortic area measured at multiple points with subclinical CVD. We found that combined CT assessment of ascending and descending aortic area may indicate a high risk of prevalent subclinical CVD elsewhere in the body independent of age, body size, and blood pressure.

Keywords: Computerized tomography, Cardiac CT, Ultrasound, Epidemiology, Risk factors, Cardiovascular disease.