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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 (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.005), total and LDL cholesterol (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.002,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.001), and increased achievement of SBP\u2009&lt;\u2009130 mmHg (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.046), and LDL cholesterol\u2009&lt;\u200970 or\u2009&lt;\u200955 mg\/dL (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.001,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.003). 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,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.014, and 0.15,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.004, respectively). In conclusion, results provide proof-of-concept that in cTBAS, strict dual AI\/LL medical therapy is feasible and associated with favorable outcomes.\n                  <\/jats:p>","DOI":"10.1007\/s11739-026-04348-4","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T17:46:05Z","timestamp":1776707165000},"page":"1635-1646","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Response to dual anti-impulse and lipid-lowering therapy is associated with clinical outcomes in chronic type B aortic syndrome"],"prefix":"10.1007","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2193-0509","authenticated-orcid":false,"given":"Paolo","family":"Bima","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrizia","family":"Ferrera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elvira","family":"Fanelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Revello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"La Torre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Pivetta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Rinaldi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Verzini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Lupia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7833-9632","authenticated-orcid":false,"given":"Fulvio","family":"Morello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"4348_CR1","doi-asserted-by":"publisher","first-page":"2611","DOI":"10.1161\/CIRCULATIONAHA.106.630400","volume":"114","author":"C Olsson","year":"2006","unstructured":"Olsson C, Thelin S, Stahle E, Ekbom A, Granath F (2006) Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002. 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FM received grants from the Universit\u00e0 degli Studi di Torino (MORF_RILO_21_02, MORF_RILO_23_03). EL received a grant from Fondazione Ricerca Molinette (2023). PB received a grant from the Swiss Heart Foundation (FF23602) unrelated to the present work. FV receives scientific consultancy fees from WL Gore and Cook, unrelated to the present work.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study protocol conformed to the Declaration of Helsinki and was approved by the local institutional Ethics Committee (42\/2020, prot. 0029448).","order":2,"name":"Ethics","label":"Human and animal rights","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All participants provided informed consent, and data were collected anonymously, in compliance with data protection regulations.","order":3,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Declarations"}}]}}