Should I be concerned about how at risk I am for rupture with a 4.2 cm

I live in the UP of Michigan. The closest major center is Mayo Rochester. It's a six hour drive more or less. There are several other good options that are about 10-12 hours away.

I believe 4.2 is small by all measures. I think (but am not certain at all) that even people with a genetic predisposition don't typically get surgery at 4.2. I think/hope we could both count on getting appointments for an actual surgery if it becomes necessary. The monitoring is important, but that doesn't require being at a top center (though better if you can get it). Yet there is always that niggling doubt that I would be turned away from the centers I'd like to perform the surgery. Just have to live with it I guess.

They don't ever test the growth per se, so far as I know. They set the imaging frequency to make it very unlikely the aneurysm would grow between images so much that surgery would be warranted. It's all based on statistics I guess. My attitude is to take comfort in the fact that I'm probably "usual". So we're in pretty good shape between 4 and 4.5. Things get more "serious" once it starts getting around 5cm. But even then, there is some evidence that surgery is more risky than waiting until 5.5cm. So far as I know, at that point, you have to take into account details like the patient's health and the success rate of the center doing the surgery. There are always outliers, but they are rare. ;-).

I'm not sure when you got your diagnosis. Mine was going on two years ago. It has definitely gotten significantly easier to live with. Reading up has also helped.

Good luck!

You need to be on medication to lower your blood pressure and a statin for cholesterol. You don’t need to worry about a rupture at 4.2. It’s essentially not an aneurysm, it’s a dilation.
You would have a difficult time finding anyone that would operate on a 4.2. The risk of surgery is more then the risk of a 4.2 dilation.
Time helps the worry lessen!! It does get better!! Try to relax and enjoy your life!!

I think your physician gave you good advice - or implied good advice. You can control your hypertension with medications and you can bring down your high cholesterol with medications. You will want your cholesterol as low as possible -- less than 150, for certain. Your LDL-C should be less than 50. Those are important first steps.
I would suggest testing for lipoprotein(a) also. This is an inherited lipoprotein, which is very atherogenic and maybe contributed to your aneurysm, if it is high. This test probably will not be covered by your insurance but if you have a higher than normal value (< 75) then you can take a drug like Repatha. LabCorp charges $49 for a lipoprotein (a) test if you "go direct" and Quest probably charges the same or less. (Mine went through my insurance and I wound up paying $129 because it was not covered.)

Mine is 4.8. And I have an aortic root aneurysm at 4.0. I am seeing a cardiologist in September at Rochester. I live 4 hours from there. My cardiologist here in Wisconsin does not surgery.

After having a car accident in which I broke some ribs I was diagnosed with a 4.4 cm upper aortic aneurysm eight years ago. I keep my BP under control and avoid lifting anything over 40 lbs so I’m not straining. I have an annual CAT scan for monitoring the size and it hasn’t grown since. I am now 70 years old and for the most part I don’t really think about it. Relax and enjoy your life. My personal relationship with Jesus, going back 50 years, is a great source of peace and comfort. All the best to you my friend.