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Dear Dr. Roach: Two weeks ago, my sister-in-law, age 74 and in excellent health, collapsed and died suddenly and unexpectedly while working full time at a nearby university. The autopsy reports that she died from aorta root rupture. My brother and all of us need to more fully understand these words. What causes aorta root rupture? What are its symptoms? Does stress play a significant part in this kind of death? Is this genetic?

My brother is struggling terribly with his wife's death, as are all in the family. Any help you can give us will be deeply appreciated.

M.B.

Dear M.B.: I am sorry to hear about your sister-in-law.

The aortic root is the beginning of the aorta, the largest blood vessel in the body. The root is right where it begins at the aortic valve, where blood comes out of the left ventricle. A rupture at this point almost always means an aneurysm, an enlargement of the blood vessel. As the blood vessel expands, it thins; the pressure against the wall of the vessel increases, further increasing the risk of rupture.

The most common risk factors for aortic root aneurysm are smoking, high blood pressure, diabetes and high cholesterol. However, even with multiple risk factors, this is a rare condition (seen in about one person in 10,000), and it is much more likely in men than in women. Stress may increase blood pressure, and can predispose people to bad habits, but it is not a direct risk for aortic aneurysm or rupture.

Marfan syndrome is a genetic condition characteristically associated with aneurysms of the aortic root. People with Marfan syndrome — which is caused by an abnormal gene for the structural protein fibrillin — often are taller than their parents, with disproportionally long arms and certain other characteristics of their chest, eyes and hard palate. Even so, some people are never diagnosed, partly because the range of expression of the condition is broad.

Most authorities recommend that first-degree family members (siblings, children) of people who had a dilatation or aneurysm of the thoracic aorta get evaluated by a screening test. I would recommend that your sister-in-law's immediate family discuss this with their physicians.

More information is available at marfan.org.

Dear Dr. Roach: My husband has high triglycerides, and his HDL is always low. He has a heart condition and is under a great doctor’s care.

We are wondering if you have any suggestions that might help to improve the levels for both.

L.D.

Dear L.D.: The combination of high triglycerides and low HDL is common, and often relates to a condition called “metabolic syndrome.” A large waistline and high blood pressure often go along with this condition, but the major concern is development of prediabetes or diabetes. Losing even a few pounds can really help reduce this risk.

Although there are medications for this condition, such as metformin and statins, many people can effectively treat this with a careful diet, especially avoiding excess processed carbohydrates and simple sugars, and getting regular exercise, such as a brisk 30-minute walk per day (on top of, not instead of, whatever else he might be doing).

Email questions to ToYourGoodHealth@med.cornell.edu.

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