AAA risk is not just “age and diameter”: this review shows smoking as the dominant driver, diabetes as a paradoxically protective signal, and women as lower-prevalence but higher-risk patients once aneurysm develops. The full evidence map explains which biological, anatomical, genetic, and post-EVAR surveillance signals may move AAA risk assessment beyond diameter alone.
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Abstract: To synthesize the current body of evidence regarding the multi-dimensional risk factors associated with the incidence, expansion, and rupture of abdominal aortic aneurysms, as well as the predictors of postoperative complications and mortality. The review cites 224 references and is based on 1392 original studies comprising 21004519 total participants (topic-deduplicated ΣN). Within this evidence map, cigarette smoking emerged as the dominant and most consistently replicated risk signal for abdominal aortic aneurysm, with screening cohorts reporting odds ratios as high as 5.57 in male veterans and hazards up to 15.59 in older Swedish men, while diabetes mellitus was paradoxically associated with a 37% to 63% lower probability of aneurysm growth. The synthesis indicates that traditional drivers such as older age, male sex, hypertension, and adverse lipid profiles remain central to incidence, while women showed lower prevalence yet higher rupture risk and worse postoperative mortality, including an odds ratio of 1.68 for mortality after elective repair in registry data. Mechanistic and predictive signals converged around biomechanical metrics including peak wall rupture index and low wall shear stress, intraluminal thrombus burden, inflammatory markers such as high-sensitivity C-reactive protein, coagulation biomarkers like D-dimer, and emerging proteomic and polygenic risk scores that outperform diameter alone. Clinically, the map supports rigorous post-endovascular surveillance, pharmacological optimization with statins and metformin, and consideration of expanded screening for high-risk subgroups missed by current age- and sex-based criteria. Heterogeneity in alcohol, lipid, and biomarker findings, together with the predominantly retrospective and observational nature of included evidence, limits causal interpretation. Future research should prioritize prospective validation of integrated biomechanical, proteomic, and polygenic risk models alongside sex-specific intervention thresholds to advance personalized screening and rupture-risk stratification beyond maximum diameter.
Final search date and database lock: 2026-05-01 21:17:03 CEST
Plan: Pro (expanded craft tokens; source: PubMed)
Source: PubMed
Total Abstracts/Papers: 2424
Downloaded Abstracts/Papers: 2424
Included original and non-original Abstracts/Papers (all): 1473
Included original Abstracts/Papers (Vote counting by direction of effect): 1392
Reference Index (links used in paper): 224
Total participants (topic deduplicated ΣN): 21004519
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[1265] Serum anti-Mullerian hormone (AMH) levels correlate with infrarenal aortic diameter in healthy older men: is AMH a cardiovascular hormone? — https://doi.org/10.1530/joe-13-0125
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