Impact of Atherosclerotic Conditions and Cardiovascular Medications on Abdominal Aortic Aneurysm Growth

Fahad Alkhalfan; Essa Hariri; Anu Aggarwal; Robert Burton; Bhairavi Rajasekar; Alliefair Scalise; Pulkit Chaudhury; Natalia Fendrikova Mahlay; A Phillip Owens 3rd; Scott J Cameron

doi:10.1016/j.amjmed.2025.06.040

Impact of Atherosclerotic Conditions and Cardiovascular Medications on Abdominal Aortic Aneurysm Growth

Am J Med. 2025 Jun 25:S0002-9343(25)00408-5. doi: 10.1016/j.amjmed.2025.06.040. Online ahead of print.

Authors

Affiliations

¹ Section of Vascular Medicine, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA; Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic Lerner Research Institute of Case Western Reserve University, Cleveland, OH, USA.
² Division of Cardiology, Johns Hopkins Medicine, Baltimore, Maryland, USA.
³ Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic Lerner Research Institute of Case Western Reserve University, Cleveland, OH, USA.
⁴ Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.
⁵ Section of Vascular Medicine, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
⁶ Department of Internal Medicine, Division of Cardiovascular Health and Disease, University of Cincinnati, OH, USA.
⁷ Section of Vascular Medicine, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA; Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic Lerner Research Institute of Case Western Reserve University, Cleveland, OH, USA; Department of Hematology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address: cameros3@ccf.org.

PMID: 40578465
DOI: 10.1016/j.amjmed.2025.06.040

Abstract

Background: While risk factors for atherosclerotic diseases and abdominal aortic aneurysms overlap, some risk factors, like diabetes, may slow aneurysm growth. The impact of atherosclerosis and its treatment on aneurysm growth is unknown. We aimed to investigate whether atherosclerotic conditions and cardiovascular medications are associated with faster aneurysm growth.

Methods: Annualized abdominal aortic aneurysm growth rates were assessed over 10 years. The presence of coronary artery disease, peripheral artery disease, renal artery stenosis, and internal carotid artery stenosis was ascertained from vascular studies. Multivariable logistic regression models assessed the association between atherosclerotic conditions and fast aneurysm growth (≥0.5 cm/year). We further stratified by medication use, including aspirin.

Results: Coronary artery disease, carotid artery stenosis, and renal artery stenosis were associated with reduced odds of fast aortic aneurysm growth, likely due to medications for treating these conditions. Aspirin was the only medication to show slower aneurysm growth regardless of disease co-morbidity. Patients with peripheral artery disease not managed by medications had faster aneurysm growth than those without peripheral artery disease. The addition of a Statin mediction was associated with a further reduction if fast aneurysm growth in patients with peripheral artery disease already taking aspirin.

Conclusion: Atherosclerosis in vascular beds outside of the aorta was associated with a lower risk of fast aneurysm growth. Peripheral artery disease without pharmacological therapy had higher rates of fast aneurysm growth. Aspirin showed decreased aneurysm growth regardless of the co-incident vascular disease in patients with aortic aneurysms, highlighting the importance of appropriate pharmacological therapy.

Keywords: Abdominal aortic aneurysms; atherosclerosis diabetes; carotid artery disease; peripheral artery disease.