Obesity's Role in Acute Aortic Dissection: An Expanding Risk Factor

Obesity is driving an earlier and higher incidence of acute aortic dissection, particularly in younger men, raising diagnostic and management stakes for frontline clinicians.

Population analyses show higher BMI independently increases dissection risk and shifts onset to younger ages, with presentations occurring several years earlier. A male predominance is evident in higher-BMI cohorts, with clustering of hypertension and metabolic comorbidity. These data suggest a higher pretest probability of AAD in young obese men presenting with chest or back pain.

Current reviews point to obesity-related perivascular adipose tissue (PVAT) dysfunction as a mechanistic contributor: PVAT-driven local inflammation and oxidative stress extend into the aortic wall, promoting endothelial dysfunction, upregulating matrix metalloproteinases, and accelerating extracellular matrix remodeling. Increased cardiac output and blood viscosity further raise hemodynamic load on a structurally compromised aorta, together increasing susceptibility to dissection.

Management implications include a lower threshold for diagnostic imaging and closer perioperative coordination in obese patients with suspected dissection. Imaging vigilance may mean earlier CT or MR at smaller diameter thresholds, attention to scanner weight limits, and protocol adjustments for contrast dosing and image quality in larger body habitus. Perioperative planning should anticipate airway challenges, hemodynamic volatility, and intensified postoperative respiratory and wound surveillance.