Could Your Family History Reveal an Aortic Aneurysm Risk?

Many people know that a family history of heart disease can increase their risk of heart attacks or high blood pressure. Fewer realize that inherited factors can also play a major role in another potentially life-threatening condition: an aortic aneurysm.

An aortic aneurysm develops when a weakened area of the aorta — the body's largest artery — begins to bulge outward. Over time, that weakened section can continue to enlarge. If the aneurysm ruptures or the layers of the aortic wall separate, a condition called an aortic dissection, it becomes a medical emergency that requires immediate treatment.

Because most aneurysms develop without causing symptoms, they often go undetected until they are discovered during imaging for another reason or after a serious complication occurs. That makes understanding personal risk factors, especially family history, one of the most important steps people can take, according to Bradley S. Taylor, M.D., MPH, cardiac surgeon, chief of cardiac surgery for the North Region, and chief of quality and outcomes at Baptist Health Heart & Vascular Care.

"Aneurysmal disease of the aorta is often a silent problem,” says Dr. Taylor, in a recent Baptist Health Instagram reel. “And patients don't become aware of it unless it's either detected through surveillance with their physicians or if it acutely ruptures or dissects, which is a medical emergency."

What Is an Aortic Aneurysm?

The aorta carries oxygen-rich blood from the heart to the rest of the body. An aneurysm occurs when part of the artery wall weakens and begins to stretch outward like a balloon.

Aneurysms can develop in different parts of the aorta. Thoracic aortic aneurysms occur in the chest, while abdominal aortic aneurysms develop in the portion of the aorta that runs through the abdomen.

The danger is not simply the aneurysm itself but what can happen if it grows too large. A rupture can cause life-threatening internal bleeding. An aortic dissection occurs when a tear develops in the inner layer of the aorta, allowing blood to separate the layers of the artery wall. Both conditions require emergency medical care.

Although these events are relatively uncommon, they carry high mortality rates if not treated quickly.

Why Family History Matters

While aging, smoking and high blood pressure are well-known risk factors for aneurysms, genetics also play an important role.

Research has shown that people with a first-degree relative — such as a parent, sibling or child — who has had an aortic aneurysm or dissection face a significantly higher risk themselves. In some families, inherited disorders that affect connective tissue, such as Marfan syndrome, Loeys-Dietz syndrome and vascular Ehlers-Danlos syndrome, dramatically increase the likelihood of developing aortic disease. Even without one of these rare conditions, aneurysms can run in families.

For that reason, physicians encourage patients to learn about illnesses affecting close relatives whenever possible.

"We want to evaluate people and find their aortic disease before it becomes a life-threatening problem," Dr. Taylor says. "Family history is probably the most important thing to pay attention to." 

Unlike many other health risks that develop gradually over decades, inherited aortic disease may appear earlier in life than expected. Knowing about a relative's diagnosis may prompt earlier screening that could detect an aneurysm before it causes problems.

Which Family History Should Raise Concern?

Not every relative with cardiovascular disease increases aneurysm risk. Instead, doctors focus on specific diagnoses involving the aorta.

According to Dr. Taylor, particular attention should be paid if close family members have experienced:

• An aortic aneurysm
• An aortic dissection
• Surgery to repair an aneurysm or diseased aorta
• Sudden unexplained death related to an aortic rupture or dissection, especially at a younger age

"If somebody in your family has a history, particularly at a young age, of aneurysm disease or death from a dissection, or been treated for an aortic issue, you need to seek care," Dr. Taylor says. "And one of the things to think about is that we become our parents because we carry their genetic code." 

The younger the affected relative was at diagnosis, the more likely genetics may have contributed to the condition.

Genes Influence Risk — Not Destiny

Learning that an inherited condition may increase risk can be unsettling. However, having a genetic predisposition does not necessarily mean someone will develop an aneurysm.

Instead, genetics help physicians determine who may benefit from closer monitoring and earlier screening.

"And so your family history is probably the most important thing to pay close attention to,” Dr. Taylor says. “But most importantly, because we carry their genes, those genes will get expressed over time. So, your risk for all things, whether it's cancer, coronary disease, aortic disease, are in our genetic code. You want to make sure that you're paying attention to that."

Knowing your family history provides valuable information that can help guide preventive care. Combined with healthy lifestyle choices and regular medical evaluations, early detection can substantially reduce the risk of catastrophic complications.

Most Aneurysms Cause No Symptoms

One of the greatest challenges with aortic aneurysms is that many people feel perfectly healthy.

Most aneurysms enlarge slowly over many years without causing pain or other warning signs. They are frequently discovered during CT scans, MRI studies or echocardiograms performed for unrelated reasons.

When symptoms do occur, they often indicate that the aneurysm has become large or is causing complications.

Possible symptoms may include:

• Deep chest, back or abdominal pain
• Pain between the shoulder blades
• Shortness of breath
• Difficulty swallowing
• Hoarseness
• A pulsating sensation in the abdomen

A sudden onset of severe chest or back pain, particularly if it feels sharp or tearing, may signal an aortic dissection. This is a medical emergency requiring immediate evaluation by calling 911.

Who Should Consider Screening?

Routine screening is not recommended for everyone. Instead, physicians recommend screening for people with higher-than-average risk.

Individuals who may benefit include:

• People with a first-degree relative who has had an aortic aneurysm or dissection
• Individuals with certain inherited connective tissue disorders
• People with bicuspid aortic valve disease, a congenital heart condition associated with enlargement of the aorta
• Older adults with a history of smoking, particularly for abdominal aortic aneurysm screening

Depending on a person's age, medical history and family history, physicians may recommend imaging tests such as an echocardiogram, CT scan or MRI to evaluate the size and health of the aorta.

If an aneurysm is found, follow-up imaging allows physicians to monitor whether it is enlarging over time.

Managing Risk Factors

Although genetics cannot be changed, many other risk factors can.

Keeping blood pressure under control is one of the most important ways to reduce stress on the aortic wall. Smoking cessation is equally important because tobacco use weakens blood vessels and accelerates aneurysm growth.

Doctors also encourage patients to:

• Stay physically active with physician-approved exercise
• Maintain a healthy weight
• Eat a heart-healthy diet rich in fruits, vegetables, whole grains and lean proteins
• Manage cholesterol and diabetes
• Take prescribed medications consistently
• Keep regular follow-up appointments if an aneurysm has already been diagnosed

These measures benefit overall cardiovascular health while helping reduce additional stress on the aorta.

Treatment Depends on Size and Growth

Not every aneurysm requires immediate surgery.

Small aneurysms are often monitored with regular imaging while physicians focus on controlling blood pressure and other cardiovascular risk factors.

However, surgery may be recommended when an aneurysm reaches a size associated with higher rupture risk, grows rapidly or causes symptoms. The type of repair depends on the aneurysm's location, size and the patient's overall health.

Advances in both open surgical techniques and minimally invasive endovascular procedures have improved outcomes, particularly when aneurysms are diagnosed before an emergency occurs.

Don't Wait for Symptoms

Because aortic aneurysms often remain silent until they become dangerous, prevention depends largely on identifying people at increased risk before complications develop.

That begins with a conversation. Ask parents, siblings and other close relatives whether anyone has ever had an aneurysm, aortic surgery or an unexplained sudden death related to the heart or major blood vessels. Share that information with your primary care physician or cardiologist, who can determine whether additional evaluation is appropriate.