**EP321: Aortic Aneurysms, Anxiety and Exercise**
**Dr. Auric Bishop:** Welcome, my name's Dr. Auric Bishop. I'm a cardiologist, an author, and a keynote speaker. I'm CEO of the Healthy Heart Network. I'm all about trying to help people live as well as possible for as long as possible. Heart disease is huge in Australia. Every 20 minutes, someone suffers a heart attack. Most of these could probably have been avoided if only we knew what to do. This podcast is all about helping you understand blood pressure, weight, cholesterol, for better health. If you enjoy this podcast, I would be honoured for a five-star review. You can share it with your family and friends. It may well save someone you love.
**Dr. Warwick Bishop:** Hi, my name is Dr. Warwick Bishop. Welcome to my podcast and videocast station. Thank you for tuning in. Today, I'm going to talk about a couple of things. First of all, something that is close and dear to my own heart: ascending thoracic aortic aneurysm. The aorta is the big blood vessel that comes out of the heart, out of the left ventricle, and supplies literally all the blood to the body. Well, in some individuals, the very first part of that aorta, soon after it comes out of the heart, can dilate; it can get bigger. When an artery dilates and gets bigger, the term we use for that medically is an aneurysm. So, an aneurysm is a dilated blood vessel.
Now, this happens to be dear to my own heart because I have an ascending aortic aneurysm, which I've had operated on and managed with what's called a PEARS procedure. I've covered PEARS before on my podcasts, and if you want to find out more about a PEARS procedure, please go to my website, type PEARS into the AI bot chatbot, and that chatbot will tell you which episode I spoke about PEARS.
But PEARS—NICE-Easy acronym—stands for Personalized External Aortic Root Support. Essentially, you get a bespoke sleeve or stocking generated from a 3D printed image of your ascending aorta that can wrap around your aorta, bringing integrity and strength to that aorta and preventing any further enlargement. That's the procedure that I had done.
But today, I'm not going to be talking about that. I'm going to be talking about a paper that came across my desk entitled "Ascending Thoracic Aortic Aneurysms Query: A Silver Lining." A group at Yale University and Yale New Haven Hospital, within the cardiothoracic department there, started to observe that for this condition, dilated ascending aorta, they tended to find that the patients had pretty clear coronary arteries.
Now, it's interesting to make that observation. Remember, when we think about dilated ascending aortas, often we see it at a relatively young age in patients with Marfan's disease. Marfan's disease is a connective tissue disorder where the integrity of the collagen, or the tissue that holds things together, is altered a little bit. Consequently, the same tissue within the aorta is altered a little bit. It doesn't work as well as it should. So, that aorta, with each pulsation and beat of the heart, gets stretched, distorted, and dilated.
Bicuspid aortic valve is also associated with dilated ascending aorta. That's my story. Bicuspid aortic valve is an abnormal valve. Normally, we see three leaflets for the aortic valve. In some people, like me, you can get two leaflets. It turns out that when that occurs, there end up being structural problems with the collagen within the early part of the aorta. So, you can end up with a dilated ascending aorta at a relatively young age. I'll say just under 60 is relatively young because that's where I happen to be.
Anyway, this particular group has observed across the board that when they're operating on these people, they seem to have lower rates of coronary artery disease, which I guess is a silver lining. It means when an aorta is being operated on, there isn't a requirement to necessarily be dealing with bad arteries as well.
Well, they've postulated a couple of reasons why that may be the case. Whether these are valid or not, I'm not sure. To be honest, I don't think it makes a great deal of difference clinically. From where I sit, the most important thing in regard to the ascending aorta is to know that it's there and to operate on it before it causes a problem. Mainly because if you have a problem with your ascending aorta—if it tears or ruptures—the mortality is well over 90%. So, you don't get another go.
To my mind, I think the most important thing is to make sure the aorta is sorted. If the coronary arteries are good, bad, or indifferent, well, it turns out most of our therapies these days for coronary artery disease work surprisingly well. So, having a silver lining, if not too much going on with your coronary arteries, is interesting, but from where I'm sitting, not particularly relevant.
Anyway, why might these individuals have a reduced risk of coronary artery problems as their aorta dilates? Well, first of all, this group suggested that the thickness within the aorta, the intima media thickness, is reduced. By doing that, that can translate to reduced rates of myocardial infarction and stroke. It also turns out that this cohort of patients, for whatever reason, tends to have lower LDL cholesterol, at least lower than age-matched equivalents. Not surprisingly, when they look at calcium scores of these individuals, their calcium score is a little bit lower.
So, an unusual so-called silver lining, but one that's worth thinking about. The most important aspect, certainly from the potential consequence of problems from the ascending aorta, is in regard to how you manage that. If you do identify coronary artery disease at the same time, then obviously you would have people on lipid-lowering therapies and, if appropriate, aspirin as well.
When it comes to operating on these aortas, we normally expect the aorta as it comes out of the heart to be about 35mm. Now, of course, that's different a little between men and women, and it's a little bit different between small men and big men, and small women and large women, and small women and large men. So, we often standardise or index those measurements, but 35 millimeters is not a bad starting point when we are measuring these aortas.
When they're a centimeter too big—so about 45 millimeters—we start to get a bit worried. When they're getting up to 50 millimeters, we get more worried. I had mine operated on at approximately 49 millimeters, and at 55 millimeters, we bite the bullet, we get in, and we operate. Currently, the operation most often performed is a removal of the diseased or affected piece of aorta. It's cut out, and a replacement piece of graft, synthetic material, is put in its place. This is the most common way it's dealt with.
If a valve has to be done at the same time, then the valve gets operated on as well. For my situation, my valve was working okay, and so to put a wraparound sleeve on the aorta to stop it changing size any further and bring integrity to the tissue was a great outcome for me—the PEARS procedure.
If anyone is listening to this and does have aortic issues or knows of someone with aortic issues, please ask some questions about the PEARS procedure and whether it's appropriate for the person you're thinking of. For now, however, I'm not really sure there is a silver lining for ascending thoracic aortic aneurysms. Having gone through the surgery, I can tell you it's a pretty big deal of its own, and I can't say that I specifically thought that I should thank my lucky stars for not having any coronary disease associated.
Having shared the joys of ascending aortic aneurysm, I thought I might finish on a little bit of anxiety. This paper study came across my desk, and it's titled "10 Minutes of Activity a Day Keeps Anxiety at Bay." This was from the Irish Longitudinal Study Group, who really grabbed a bunch of older patients—relatively inactive, nearly just over 7,500 patients in actual fact, mean age around 65—and looked at activity levels and rates of general anxiety disorder.
It turned out that those with the lowest physical activity—participants really undertaking the lowest physical activity on a daily basis or a weekly basis—had the highest likelihood of general anxiety disorder. Participants with the highest physical activity had a 23% lower rate of general anxiety disorder in comparison.
The headline is that they observed, and this is longitudinal, not a randomized controlled trial, that about 10 minutes daily for 5 days out of a 7-day week could significantly impact the likelihood of developing general anxiety disorder. Now, I think we already know that there are so many benefits of exercise—not just the physiological changes, better sugar, better blood pressure, better glucose and diabetic control, etc., etc. Not just better muscles and strength, but we know it's also better for mood. This is just another little study that supports that. Nothing particularly surprising, but a nice reminder to get out there and do something with some regularity.
For now, I'm going to wish you the very best. I'm going to wrap up now. I hope you've learned something. If you've got any queries or questions, drop us a note at info@drwarwickbishop.online. I really do appreciate you tuning in and listening. I would love you to share this and subscribe. Till next time, I hope you live as well as possible for as long as possible. Take care and bye for now.
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