Metformin and AAA

Q: Metformin has a protective effect on Abdominal Aortic Aneurysm (AAA).

A) True

B) False

Answer: A

Overall, diabetes mellitus has been negatively associated with AAA. Many of us may find this counterintuitive, but this can be explained by the fact that atherosclerosis and AAA are two different pathophysiology. The odds ratio of AAA among patients with diabetes compared with nondiabetics is remarkably around 0.52 and 0.75.

Upon further examination of this data, one possible reason may be the protective effect of anti-diabetic medications, particularly Metformin, which independently reduces inflammatory markers in vitro and AAA growth in human studies. Other meds used in Diabetes, such as statins, angiotensin converting enzyme inhibitors (ACE-Is), angiotensin receptor blockers (ARBs), fenofibrate, and some hypoglycemic agents, also have a potential modest protection on AAA.

#cardiovascular

#Endocrine

#pharmacology

#epidemiology

References:

1. Kent KC, Zwolak RM, Egorova NN, et al. Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals. J Vasc Surg 2010; 52:539.

2. Shantikumar S, Ajjan R, Porter KE, Scott DJ. Diabetes and the abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 2010; 39:200.

3. Aune D, Schlesinger S, Norat T, Riboli E. Diabetes mellitus and the risk of abdominal aortic aneurysm: A systematic review and meta-analysis of prospective studies. J Diabetes Complications 2018; 32:1169.

4. Pafili K, Gouni-Berthold I, Papanas N, Mikhailidis DP. Abdominal aortic aneurysms and diabetes mellitus. J Diabetes Complications 2015; 29:1330.

5. Raffort J, Hassen-Khodja R, Jean-Baptiste E, Lareyre F. Relationship between metformin and abdominal aortic aneurysm. J Vasc Surg 2020; 71:1056.