Medical Management of Abdominal Aortic Aneurysm: Scoping Review with ☸️SAIMSARA.

Name: SAIMSARA Evidence Object vascular::MEDICATION_AAA_PM
Creator: SAIMSARA
License: https://saimsara.com/license/

SAIMSARA

doi:10.62487/saimsara81bc962f

Medical Management of Abdominal Aortic Aneurysm: Scoping Review with ☸️SAIMSARA.

Issue 1, Volume 1, 2026

Editorial note

• Last update: 2026-04-12 19:52:58

What is this paper about

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.

Evidence preview · Did you know?

Realistic clinical scene showing an abdominal aortic aneurysm patient discussing long-term medication prevention with a vascular specialist.

AAA care is not only surveillance

Did you know? In AAA repair cohorts, statin therapy combined with antiplatelet therapy was associated with markedly better 5-year survival, with HR 0.5 reported for long-term survival.

This makes AAA medical management a survival issue, not just a rupture-watch strategy.

Medical-science image showing statin tablets beside an abdominal aortic aneurysm scan and vascular inflammation markers.

One rupture signal stands out

Did you know? Statin use was linked to lower risk of large AAA rupture, with OR 0.50 and 95% CI 0.32–0.77.

The signal suggests that anti-inflammatory and plaque-stabilizing effects may matter beyond cholesterol control.

Clinical medication-safety scene showing antiplatelet therapy, EVAR follow-up, and bleeding-risk assessment.

More medication is not always better

Did you know? After standard EVAR, dual antiplatelet therapy did not improve cardiovascular or procedural outcomes in patients without ASCVD, but increased bleeding risk with HR 1.20.

This is the safeguard message: optimization matters, but escalation needs evidence.

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Abstract:

Keywords:

Review Stats

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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Reference Index (69)

[1] Medium-Dose Formoterol Attenuated Abdominal Aortic Aneurysm Induced by EPO via β2AR/cAMP/SIRT1 Pathway. — https://doi.org/10.1002/advs.202306232
[2] Vinpocetine alleviates the abdominal aortic aneurysm progression via VSMCs SIRT1-p21 signaling pathway. — https://doi.org/10.1038/s41401-024-01358-w
[3] Lack of an effective drug therapy for abdominal aortic aneurysm. — https://doi.org/10.1111/joim.12958
[4] Individual risk assessment for rupture of abdominal aortic aneurysm using artificial intelligence. — https://doi.org/10.1016/j.jvs.2024.11.017
[5] Diabetes mellitus as a protective factor of abdominal aortic aneurysm: Possible mechanisms. — https://doi.org/10.1016/j.arteri.2018.01.002
[6] Pathogenic and Therapeutic Significance of Angiotensin II Type I Receptor in Abdominal Aortic Aneurysms. — https://doi.org/10.2174/1389450119666180122155642
[7] Inflammatory markers associated with abdominal aortic aneurysm. — https://doi.org/10.1684/ecn.2016.0381
[8] Impact of Atherosclerotic Conditions and Cardiovascular Medications on Abdominal Aortic Aneurysm Growth. — https://doi.org/10.1016/j.amjmed.2025.06.040
[9] Editor's Choice - Metformin to Inhibit Progression of Abdominal Aortic Aneurysm: A Randomised, Placebo Controlled Clinical Trial. — https://doi.org/10.1016/j.ejvs.2025.04.052
[10] Exploring Drug Re-Purposing for Treatment of Abdominal Aortic Aneurysms: a Systematic Review and Meta-analysis. — https://doi.org/10.1016/j.ejvs.2023.11.037
[11] A prospective longitudinal study of risk factors for abdominal aortic aneurysm. — https://doi.org/10.14814/phy2.16130
[13] Temporal trends in abdominal aortic aneurysmal disease: a nationwide cohort study on cardiovascular morbidity and medical cardioprotective therapy. — https://doi.org/10.1093/eurjpc/zwac105
[14] Outcomes of translumbar embolization of type II endoleaks following endovascular abdominal aortic aneurysm repair. — https://doi.org/10.1016/j.jvs.2021.06.030
[15] Dihydropiridine calcium-channel blockers and perioperative mortality in aortic aneurysm surgery. — https://doi.org/10.1093/bja/aen173
[16] Optimal Time for Pharmacological Treatment of Abdominal Aortic Aneurysm. — https://doi.org/10.2174/1389450119666171227225008
[17] Endothelium as a Potential Target for Treatment of Abdominal Aortic Aneurysm. — https://doi.org/10.1155/2018/6306542
[18] Abdominal aortic aneurysm: pathogenesis and implications for management. — https://doi.org/10.1161/01.atv.0000245819.32762.cb
[19] Combination of folic acid with nifedipine is completely effective in attenuating aortic aneurysm formation as a novel oral medication. — https://doi.org/10.1016/j.redox.2022.102521
[20] Cardiac medical therapy among patients undergoing abdominal aortic aneurysm repair. — https://doi.org/10.1007/s10016-006-9078-z
[21] Dipeptidyl peptidase-4 inhibitor decreases abdominal aortic aneurysm formation through GLP-1-dependent monocytic activity in mice. — https://doi.org/10.1371/journal.pone.0121077
[22] Metformin treatment status and abdominal aortic aneurysm disease progression. — https://doi.org/10.1016/j.jvs.2016.02.020
[23] Metformin prescription status and abdominal aortic aneurysm disease progression in the U.S. veteran population. — https://doi.org/10.1016/j.jvs.2018.06.194
[24] A retrospective study: Factors associated with the risk of abdominal aortic aneurysm rupture. — https://doi.org/10.1016/j.vph.2014.11.006
[25] Association of Oral Anticoagulation Prescription with Clinical Events in Patients with an Asymptomatic Unrepaired Abdominal Aortic Aneurysm. — https://doi.org/10.3390/biomedicines10092112
[26] In vivo study on the expression pattern of resistin in patients with abdominal aortic aneurysm. — https://doi.org/10.1177/1538574410380935
[27] Risk factors and prevalence of perioperative cognitive dysfunction in abdominal aneurysm patients. — https://doi.org/10.1016/j.jvs.2005.07.032
[31] Randomized Placebo-Controlled Trial Assessing the Effect of 24-Week Fenofibrate Therapy on Circulating Markers of Abdominal Aortic Aneurysm: Outcomes From the FAME -2 Trial. — https://doi.org/10.1161/jaha.118.009866
[32] Abdominal aortic aneurysm growth rates in patients undergoing local ultrasound surveillance. — https://doi.org/10.1177/1742271x221093751
[33] Abdominal aortic aneurysm: a review on the role of oral antidiabetic drugs. — https://doi.org/10.23736/s0392-9590.20.04362-x
[34] Adherence to Prescribed Drugs Among 65-74 Year Old Men Diagnosed with Abdominal Aortic Aneurysm or Peripheral Arterial Disease in a Screening Trial: A VIVA Substudy. — https://doi.org/10.1016/j.ejvs.2018.09.023
[35] Efficacy and Safety of Antiplatelet Therapy After Endovascular Aortic Repair: A Target Trial Emulation. — https://doi.org/10.1161/jaha.125.044102
[36] Editor's Choice - Association Between Metformin Prescription and Abdominal Aortic Aneurysm Growth and Clinical Events: a Systematic Review and Meta-Analysis. — https://doi.org/10.1016/j.ejvs.2021.06.013
[38] Underutilization of Nonopioid Pain Medication in Patients Undergoing Abdominal Aortic Aneurysm Repair. — https://doi.org/10.1016/j.avsg.2020.04.068
[39] Intravenous ketorolac is associated with reduced mortality and morbidity after open abdominal aortic aneurysm repair. — https://doi.org/10.1177/1708538120914454
[40] Pharmacological treatment of vascular risk factors for reducing mortality and cardiovascular events in patients with abdominal aortic aneurysm. — https://doi.org/10.1002/14651858.cd010447.pub3
[42] Platelet olfactory receptor activation limits platelet reactivity and growth of aortic aneurysms. — https://doi.org/10.1172/jci152373
[43] Statin use, development of sarcopenia, and long-term survival after endovascular aortic repair. — https://doi.org/10.1016/j.jvs.2021.04.054
[44] Influence of cardiometabolic medications on abdominal aortic aneurysm growth in the UK Aneurysm Growth Study: metformin and angiotensin-converting enzyme inhibitors associated with slower aneurysm growth. — https://doi.org/10.1093/bjs/znad375
[45] Assessing Cardiovascular Risk and Medication Management in Patients with Abdominal Aortic Aneurysm across Three Decades. — https://doi.org/10.1016/j.ejvs.2025.02.031
[46] Long-term cardiac outcome in high-risk patients undergoing elective endovascular or open infrarenal abdominal aortic aneurysm repair. — https://doi.org/10.1016/j.ejvs.2008.09.008
[47] Medical treatment for small abdominal aortic aneurysms. — https://doi.org/10.1002/14651858.cd009536.pub2
[50] Radiomic-based Textural Analysis of Intraluminal Thrombus in Aortic Abdominal Aneurysms: A Demonstration of Automated Workflow. — https://doi.org/10.1007/s12265-023-10404-7
[52] Derivation and Validation of a 10-Year Risk Score for Symptomatic Abdominal Aortic Aneurysm: Cohort Study of Nearly 500 000 Individuals. — https://doi.org/10.1161/circulationaha.120.053022
[53] Endovascular repair combined with adjunctive procedures in the treatment of tuberculous infected native aortic aneurysms. — https://doi.org/10.1016/j.jvs.2022.01.136
[55] [Factors with Impact on the Outcome after Surgical Interventions for Abdominal Aortic Aneurysms]. — https://doi.org/10.1055/s-0035-1545991
[57] A Systematic Review and Meta-Analysis of the Incidence and Risk Factors for Major Adverse Cardiovascular Events in Patients with Unrepaired Abdominal Aortic Aneurysms. — https://doi.org/10.3390/biomedicines11041178
[60] Quantifying the risks of hypertension, age, sex and smoking in patients with abdominal aortic aneurysm. — https://doi.org/10.1046/j.1365-2168.2000.01353.x
[64] Clinical trial of doxycycline for matrix metalloproteinase-9 inhibition in patients with an abdominal aneurysm: doxycycline selectively depletes aortic wall neutrophils and cytotoxic T cells. — https://doi.org/10.1161/circulationaha.108.806505
[65] Association of Statin and Antiplatelet Use with Survival in Patients with AAA with and without Concomitant Atherosclerotic Occlusive Disease. — https://doi.org/10.1016/j.avsg.2022.01.014
[66] Doxycycline therapy for abdominal aneurysm: Improved proteolytic balance through reduced neutrophil content. — https://doi.org/10.1016/j.jvs.2008.09.055
[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
[71] Statin therapy is associated with improved survival after endovascular and open aneurysm repair. — https://doi.org/10.1016/j.jvs.2013.07.026
[76] NLRP3 (Nucleotide Oligomerization Domain-Like Receptor Family, Pyrin Domain Containing 3)-Caspase-1 Inflammasome Degrades Contractile Proteins: Implications for Aortic Biomechanical Dysfunction and Aneurysm and Dissection Formation. — https://doi.org/10.1161/atvbaha.116.307648
[77] Suppression of experimental aortic aneurysms: comparison of inducible nitric oxide synthase and cyclooxygenase inhibitors. — https://doi.org/10.1007/s10016-004-0174-7
[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
[80] Effect of beta-adrenergic blockade on the growth rate of abdominal aortic aneurysms. — https://doi.org/10.1001/archsurg.1988.01400290092015
[82] Maintenance of cardiodynamics with aspirin during abdominal aortic aneurysmectomy (AAA). — https://doi.org/10.1097/00000658-198111000-00008
[83] An evaluation of the effect of an angiotensin-converting enzyme inhibitor on the growth rate of small abdominal aortic aneurysms: a randomised placebo-controlled trial (AARDVARK). — https://doi.org/10.3310/hta20590
[85] The significance of endograft geometry on the incidence of intraprosthetic thrombus deposits after abdominal endovascular grafting. — https://doi.org/10.1016/j.ejvs.2009.09.004
[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
[90] A regional registry for quality assurance and improvement: the Vascular Study Group of Northern New England (VSGNNE). — https://doi.org/10.1016/j.jvs.2007.08.012
[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
[96] Cardiovascular predictors for long-term mortality after EVAR for AAA. — https://doi.org/10.1177/1358863x11425713
[97] Meeting AHA/ACC secondary prevention goals in a vascular surgery practice: an opportunity we cannot afford to miss. — https://doi.org/10.1016/j.jvs.2005.12.002
[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
[107] Level of awareness of on-treatment patients about prescribed statins. — https://doi.org/10.1007/s10557-005-5065-9

Medical Management of Abdominal Aortic Aneurysm: Scoping Review with ☸️SAIMSARA.

Cardiac & Vascular Health

Issue 1, Volume 1, 2026

AAA care is not only surveillance

One rupture signal stands out

More medication is not always better

Get access to the full paper