Response to dual anti-impulse and lipid-lowering therapy is associated with clinical outcomes in chronic type B aortic syndrome.

Chronic type B aortic syndrome (cTBAS) is a rare condition characterized by persistent dissection, intramural hematoma or penetrating ulcer within the thoracic descending or thoraco-abdominal aorta. In cTBAS, pathological aortic remodeling leads to a high burden of morbidity and mortality. Guidelines recommend medical treatment with anti-impulse (AI) and lipid-lowering (LL) drugs to improve outcomes, but underlying evidence is sparse, trials are lacking, and feasibility is unknown. We performed a retrospective observational study on consecutive patients with cTBAS followed in a medical clinic from 2021 to 2025, while receiving dual AI/LL therapy with guideline-compliant targets. Response to medical therapy and occurrence of major aortic events (MAEs) were recorded. Thirty-five patients with cTBAS (23 with aortic dissection, 10 with intramural hematoma, and 2 with penetrating aortic ulcer) were followed for a median of 28 months. A MAE occurred in 11 (31%) patients. Demographic and clinical characteristics including systolic/diastolic blood pressure (SBP/DBP), heart rate and lipid levels at baseline were similar in patients who did or did not develop MAEs. During follow-up, patients without MAEs had significant reductions in SBP (P = 0.005), total and LDL cholesterol (P = 0.002, P < 0.001), and increased achievement of SBP < 130 mmHg (P = 0.046), and LDL cholesterol < 70 or < 55 mg/dL (P < 0.001, P = 0.003). All variables were statistically unchanged in patients who developed MAEs. On-target SBP at 6 months and LDL cholesterol at 12 months were associated with protection from MAEs (hazard ratio 0.19, P = 0.014, and 0.15, P = 0.004, respectively). In conclusion, results provide proof-of-concept that in cTBAS, strict dual AI/LL medical therapy is feasible and associated with favorable outcomes.