Sex-based differences in cardiovascular risk management and abdominal aortic aneurysm growth: Insights from a contemporary cohort study

INTRODUCTION Although abdominal aortic aneurysms (AAA) are more prevalent in men, women experience more unpredictable AAA growth and rupture risk, and higher mortality. This study aimed to compare sex differences in cardiovascular risk reducing strategies and AAA outcomes. METHODS Annualized AAA growth rates and outcomes were assessed over a 10-year period in patients with at least two aortic duplex studies. We compared baseline demographics and prescribing patterns between men and women. Variables associated with fast AAA growth (≥0.5 cm/year) were identified using backward selection, and analyses were stratified by sex. RESULTS Of the 2008 patients included in this analysis, 20.0% were women. Women had higher systolic blood pressures, higher rates of smoking, and were less likely to be prescribed Statins or angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs). No significant difference was observed between men and women in the rates of rapid growth, dissection, rupture, repair, or all-cause mortality. While there were no sex-specific differences in the variables included in our final model (aspirin, metformin, coronary artery disease, smoking, and hypertension), ACEi/ARBs were associated with lower odds of fast AAA growth in women but not men, indicating a sex-specific interaction. CONCLUSION While we did not identify differences in AAA outcomes, our findings reveal a disparity in the application of cardiovascular risk reducing strategies between men and women. The observed association between ACEi/ARB use and slower growth in women, but not in men, warrants further investigation. These results underscore the need for more targeted and equitable cardiovascular risk management.