This review shows that the strongest medication signal in AAA is not true aneurysm-shrinking therapy, but better survival: statins and antiplatelet treatment repeatedly track with lower long-term mortality, while most putative growth-modifying drugs still rest on mixed or observational evidence. It maps where medical AAA care is already actionable today, where metformin and other candidates remain uncertain, and which pharmacologic strategies may genuinely change aneurysm biology rather than just cardiovascular risk.
Abstract: The aim of this review is to synthesize current evidence regarding the impact of various pharmacological agents on AAA formation, growth rates, and clinical outcomes, including mortality and perioperative complications, across animal models and human populations. The review utilises 90 original studies with 934696 total participants (topic deduplicated ΣN). This evidence map indicates that the clearest and most consistent medication-related signal in abdominal aortic aneurysm care is improved long-term survival with statin and antiplatelet therapy, including hazard ratios around 0.5-0.6 in vascular and aneurysm repair populations and an odds ratio of 0.50 for reduced large aneurysm rupture with statin use. The mapped literature also suggests that disease-modifying effects on aneurysm growth remain less certain: metformin showed slower enlargement in observational cohorts, including about -0.23 mm/year in one veteran study, whereas a randomized trial in non-diabetic patients found no significant diameter benefit over 18 months. Additional signals support a role for targeted perioperative and secondary prevention strategies, such as avoiding routine dual antiplatelet escalation after endovascular aneurysm repair because bleeding risk increased (hazard ratio 1.20) without clear outcome gain, while adherence to preventive therapy after diagnosis remained incomplete at roughly 57-60% among baseline non-users. Mechanistic animal studies further highlight vascular smooth muscle cell senescence and inflammasome pathways as plausible therapeutic targets, but translation to human benefit is still limited by heterogeneous and largely observational clinical evidence. In practice, the current map supports aggressive cardiovascular risk reduction as the most actionable medication strategy in abdominal aortic aneurysm, while future research should prioritize adequately powered randomized trials and standardized longitudinal studies to clarify which agents truly slow aneurysm growth or reduce aneurysm-specific events.
Final search date and database lock: 2026-04-12 13:23:00 CEST
Plan: Pro (expanded craft tokens; source: PubMed)
Source: PubMed
Total Abstracts/Papers: 217
Downloaded Abstracts/Papers: 217
Included original and non-original Abstracts/Papers (all): 107
Included original Abstracts/Papers (Vote counting by direction of effect): 90
Reference Index (links used in paper): 69
Total participants (topic deduplicated ΣN): 934696
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[69] Perioperative management with antiplatelet and statin medication is associated with reduced mortality following vascular surgery. — https://doi.org/10.1016/j.jvs.2013.12.013
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[79] Preoperative antiplatelet and statin treatment was not associated with reduced myocardial infarction after high-risk vascular operations in the Vascular Quality Initiative. — https://doi.org/10.1016/j.jvs.2015.08.058
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[86] Underutilization of antiplatelet and statin therapy after postoperative myocardial infarction following vascular surgery. — https://doi.org/10.1016/j.jvs.2017.06.093
[87] Perioperative asymptomatic cardiac damage after endovascular abdominal aneurysm repair is associated with poor long-term outcome. — https://doi.org/10.1016/j.jvs.2009.04.069
[88] Participation in the Vascular Quality Initiative is associated with improved perioperative medication use, which is associated with longer patient survival. — https://doi.org/10.1016/j.jvs.2014.11.073
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[91] Effect of nurse-led telephone follow-up to optimize adherence to preventive medication after screen-detected cardiovascular disease: a randomized controlled trial. — https://doi.org/10.1093/eurjcn/zvaf047
[94] Antithrombotic and Lipid Lowering Therapy is Associated With Improved Survival After Vascular Surgery: A Population Based Study From Norway. — https://doi.org/10.1016/j.ejvs.2023.10.019
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[102] Randomised trial of telephone counselling to improve participants' adherence to prescribed drugs in a vascular screening trial. — https://doi.org/10.1111/bcpt.13459
