Your enlarged aorta

27. August 2010 William Davis (19)
The thoracic aorta lives happily within the chest.

The aorta is the main artery of the body that emerges from the heart, located just under the sternum. It is the "tree trunk" from which all the major arteries branch off to the rest of the body: the arms, brain, abdominal organs, pelvis, and legs. The aorta receives the high-pressure blood ejected directly out of the heart muscle.

However, there are evil forces in the body that work to weaken the aorta. When the aorta is weakened, it enlarges. Enlarged aortas also tend to grow atherosclerotic plaque. Plaque in the aorta poses long-term risk for stroke and and mini-strokes ("transient ischemic attacks," or TIAs), due to fragmentation.

There are many enlarged aortas in this world. I see at least several every week. It is fairly common, particularly in people with high blood pressure and cholesterol abnormalities, as well as those who are overweight. Smokers get it really bad.

Conventional thinking is that, once an aorta enlarges, it will inevitably continue to enlarge at the average rate of 2.0 mm per year (resulting in 1.0 cm enlargement over 5 years). For this reason, conventional discussions on the topic of thoracic aortic aneurysms all say something like "Enlarged aortas should be monitored yearly. Surgical replacement should proceed when the aorta reaches a diameter of 5.5 cm."

This is because an aortic diameter of 5.5 cm is associated with much greater likelihood that the aorta will rupture (fatal within minutes) or the internal lining will tear, a "dissection." The surgery is a major undertaking that involves opening the chest and usually replacing the aortic valve and inserting a synthetic aorta. The procedure is high-risk, especially if any branch arteries are involved.

So putting a stop to any further aortic enlargement is a worthwhile goal. Unfortunately, conventional thought is that there is nothing you can do to stop the inevitable growth of the thoracic aorta.

Nonsense. There are a number of efforts you can make to halt further increase in aortic diameter. (My experience in this is anecdotal and unpublished, but now numbers several hundred patients.)

There are two categories of factors that cause the aorta to increase in diameter:

1) Internal pressure--Think of blood pressure as the internal inflating pressure on this "balloon." Keeping the "inflating pressure," i.e., blood pressure, low exerts substantial effect on slowing growth of aortic diameter. I aim for normal BP or lowish BP (less than 130/80, preferably 100/70).

2) Factors that weaken the aortic wall--Processes like inflammation, glycation, lipoprotein deposition, and nutritional deficiencies will serve to weaken the supportive tissue of the aorta. For that reason, correction of lipoprotein abnormalities (e.g., small LDL and lipoprotein(a)), reductions in carbohydrate intake and thereby blood glucose/glycation, and "normalization" of vitamin D, vitamin C supplementation (for collagen crosslinking), and omega-3 fatty acids all play a role.

To push even farther, there may be additional advantage to following strategies that impair the production and activity of a crucial enzyme that lives within the aortic wall: matrix metalloproteinase, or MMP. MMP degrades the collagen and other supportive tissues within the aorta, weakening it and permitting expansion. Blocking MMP may prove to be among the most powerful new strategies to halt aortic expansion.

Compounds that have potential MMP-inhibiting effects include:
--Vitamin D--A substantial effect
--Resveratrol--One of the polyphenols from red wine
--Doxycycline--This old antibiotic often used for acne treatment has, in preliminary studies, shown important MMP-blocking effects and slowed aortic expansion.

Anyway, there you have it. A bit complicated, but a "recipe" that has failed me only rarely.
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Comments (19) -

  • Kathryn

    8/27/2010 4:26:39 PM |

    These days, with the results of stats from the "gold standard" of testing (which i have seen first-hand & is not as impressive as they claim), i'd much prefer "anedotal" evidence of several hundred patients than to trust the spin of statistics from a drug company.

  • Judy B

    8/27/2010 4:47:18 PM |

    Another good article!  Of course, mainstream medicine will pooh=pooh that.  One has to take drugs!

    KevinMD has a new post that I found very disheartening.  Dr. Eric Van de Graaff has written a glowing recommendation of statin therapy.  He totally dismisses the question of side effects and the dangers of these drugs.

    Will the truth ever come out?

  • Anonymous

    8/27/2010 4:59:05 PM |

    Interesting post.

    But "evil forces in the body"?  Forces, factors, dynamics to be sure, to be sure, but I thought "evil forces" went the way of "bad humors" in medical jargon.... Wink

  • Anonymous

    8/27/2010 5:17:45 PM |

    Do you use conventional bp meds to lower blood pressure?

  • davide

    8/27/2010 5:54:25 PM |

    Dr. Davis,

    Interesting post. I have heard that pine bark extract (opc's)or grape seed extract powerfully binds with collagen to make endothelial tissue, artery walls, etc. more resilient and elastic. Studies actually have found this to be true. Have you heard about this?

  • Pasi

    8/27/2010 6:15:21 PM |

    What about athletes aortas ? Dosn't they also enlarge

  • Anonymous

    8/28/2010 10:05:45 AM |

    Thanks for this.  My dad died of an aortic aneurysm so it's good to know how I can encourage others to avoid that fate.

    You mention glucose and I was thinking of how fructose might also affect the aorta.  I've just watched Dr Lustig's talk on Sugar the bitter truth, particularly targetting high fructose corn syrup.  As I understand it, the different method of entering and interacting within the liver from glucose makes it particularly lethal.

  • ben

    8/28/2010 1:37:03 PM |

    was that you that i heard on Dr. Su's podcast?

  • Anonymous

    8/28/2010 1:44:24 PM |

    Are there any symptoms of a enlarged aorta one could look out for?

  • Jim Sutton

    8/28/2010 2:56:23 PM |

    Thanks for another informative post, Dr Davis.

    I also read the "Van de Graaff has written a glowing recommendation of statin therapy" mentioned by JudyB, and it concludes with this statement:

    "* Remarkably, there are numerous so-called experts who call into question the linkage between cholesterol and heart disease and their websites can be easily found.  The research that implicates cholesterol in vascular disease—starting with the seminal Framingham Heart Study  in the 1950s—is about as ironclad as any concept we have in modern medicine.  Those who can’t get on board with the lipid hypothesis would likely have been the same ones to reject the earth-is-round theory."

    The article can be found at http://tinyurl.com/2dm39en

    Dr Davis, would you be so kind as to give us your take on what Dr VdG has said about cholesterol, the Framingham study, etc?

  • Lub Dub

    8/28/2010 4:57:34 PM |

    Why is resveratrol part of the "recipe"?  Are there studies, preliminary or otherwise, showing an effect on MMP?

  • Kevin

    8/28/2010 5:33:46 PM |

    I don't take statins although my doctor recommended one because my cholesterol was 280.  For other reasons I've been taking an OTC medication called Beta-sitosterol for over a year.  When I donated blood last month the free cholesterol test showed mine was down to 190.  I want to quit the beta-sitosterol because of side effects.  

    I am following a lowcarb diet and trying to not eat wheat products.

    kevin

  • Anonymous

    8/29/2010 9:09:24 AM |

    milk dr. davis i hope you take that up soon Smile

  • Anonymous

    8/29/2010 7:54:21 PM |

    Placebo controlled study finds no benefit for EPA/DHA:

    http://www.reuters.com/article/idUSLDE67S02520100829

    Was the dose (400 mg) too low?

  • Geoffrey Levens

    8/29/2010 8:36:38 PM |

    "I am following a lowcarb diet and trying to not eat wheat products."

    “Do or do not... there is no try.”
    ~Yoda

    ;)

  • Pal

    8/30/2010 8:39:35 AM |

    i would like to point out additionally that vaccinations start the cascading events of neuro degenrative problems like autism and later dementia or cancer and also heart related problems which this site is trying to address, IBS/heart conditions, digestion problems from gluten and other conditions have their root in vaccines and create further damage through a poor diet.

    id urge doctor davis to take a wholistic view of this situation from the start (vaccines) of life.

    goodluck everyone.

  • Anonymous

    8/30/2010 9:58:17 AM |

    Reference the study on "Omega 3 fails to prevent repeat heart attacks".

    This is the dumbest study I have heard about in years.

    They fed them the small amount of omega 3 in MARGARINE!! This heart stopping, artery clogging hydrogenated fat based margarine was fed to them for 40 months, what did they expect would happen other than a repeat heart attack?

    http://mobile.reuters.com/article/Deals/idUSLDE67S02520100829

  • Laura

    8/30/2010 7:23:09 PM |

    Great post, Dr. Davis. Thanks for sharing, it is always informative!

  • Kamila

    8/31/2010 1:53:22 PM |

    Some comments from Cliff Richard on the secret of "eternal youth", can be summed up as tennis, red wine, lecithin and no wheat or dairy products:

    If anyone wants to see the pics:

    http://www.dailymail.co.uk/tvshowbiz/article-1307301/Sir-Cliff-Richard-Pushing-70-hes-got-body-Young-One.html

    Sir Cliff, who turns 70 in October, peeled off for his 2011 calendar.
    He says the secret of his eternal youth is tennis three times a week, two glasses of red wine a day and a daily dose of lecithin – a supplement derived from soya beans, meat and eggs – which experts claim restricts the body’s ability to form fat.
    He has also spent three years following the Blood Type diet, which means he no longer eats wheat or dairy products.

    Winning formula: Sir Cliff peeled off for his 2011 calendar
    ‘Age is not an issue if you are lucky enough to have good health,’ he says. ‘I’ve never had any major problems and spent no time in hospital.
    ‘I heard that 60 is the new 40 so I am making 70 the new 50. If you can prolong your life and hold off death for a while, why not? I would like to play tennis for my 100th birthday and I will.
    ‘My waist measures 30in, the same as 30 years ago. And my weight is 10st 7lb.’

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