Key result
Metformin is linked to ~0.38 mm/year slower abdominal aortic aneurysm growth, alongside select antihypertensives.
Why the study?
There is a clinical need for treatments to slow or prevent abdominal aortic aneurysm growth, reducing surgical need and providing options for nonsurgical candidates.
Do cardiometabolic medications (metformin, ACE inhibitors, ARBs, thiazides) reduce the growth rate of abdominal aortic aneurysms in men?
Cohort (n=3,670)
Do cardiometabolic medications (metformin, ACE inhibitors, ARBs, thiazides) reduce the growth rate of abdominal aortic aneurysms in men?
Mean Difference: -0.38
p-value: p=0.00019
Metformin, ACE inhibitors, ARBs, and thiazide diuretics are associated with slower abdominal aortic aneurysm growth in men, suggesting potential medical therapies to delay surgical intervention.
Associated with slower AAA growth; hypothesis-generating and requires RCTs before any practice change.
BACKGROUND: There is a clinical need for treatments that can slow or prevent the growth of an abdominal aortic aneurysm, not only to reduce the need for surgery, but to provide a means to treat those who cannot undergo surgery. METHODS: Analysis of the UK Aneurysm Growth Study (UKAGS) prospective cohort was conducted to test for an association between cardiometabolic medications and the growth of an abdominal aortic aneurysm above 30 mm in diameter, using linear mixed-effect models. RESULTS: A total of 3670 male participants with data available on abdominal aortic aneurysm growth, smoking status, co-morbidities, and medication history were included. The mean age at recruitment was 69.5 years, the median number of surveillance scans was 6, and the mean(s.e.) unadjusted abdominal aortic aneurysm growth rate was 1.75(0.03) mm/year. In a multivariate linear mixed-effect model, smoking (mean(s.e.) +0.305(0.07) mm/year, P = 0.00003) and antiplatelet use (mean(s.e.) +0.235(0.06) mm/year, P = 0.00018) were found to be associated with more rapid abdominal aortic aneurysm growth, whilst metformin was strongly associated with slower abdominal aortic aneurysm growth (mean(s.e.) -0.38(0.1) mm/year, P = 0.00019), as were angiotensin-converting enzyme inhibitors (mean(s.e.) -0.243(0.07) mm/year, P = 0.0004), angiotensin II receptor antagonists (mean(s.e.) -0.253(0.08) mm/year, P = 0.00255), and thiazides/related diuretics (mean(s.e.) -0.307(0.09) mm/year, P = 0.00078). CONCLUSION: The strong association of metformin with slower abdominal aortic aneurysm growth highlights the importance of the ongoing clinical trials assessing the effectiveness of metformin with regard to the prevention of abdominal aortic aneurysm growth and/or rupture. The association of angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, and diuretics with slower abdominal aortic aneurysm growth points to the possibility that optimization of cardiovascular risk management as part of abdominal aortic aneurysm surveillance may have the secondary benefit of also reducing abdominal aortic aneurysm growth rates.
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Gellatly et al. (2023) conducted a cohort in Abdominal aortic aneurysm (n=3,670). Cardiometabolic medications (metformin, ACE inhibitors, ARBs, thiazides) vs. Non-use was evaluated on Abdominal aortic aneurysm growth rate (mm/year) (MD -0.38 mm/year (for metformin), p=0.00019). Metformin exposure was strongly associated with slower abdominal aortic aneurysm growth (mean difference -0.38 mm/year, P=0.00019), alongside ACE inhibitors, ARBs, and thiazides.
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