Diabetes mellitus and abdominal aortic aneurysm growth: Clinical evidence and mechanistic insights.

Abstract

BackgroundDiabetes mellitus (DM) has paradoxically been associated with slower abdominal aortic aneurysm (AAA) growth, despite its adverse vascular profile.MethodsWe present a focused synthesis of contemporary longitudinal cohort studies reporting AAA growth rates according to diabetes status and metformin exposure.ResultsAcross six independent cohorts, patients with diabetes consistently exhibited slower aneurysm expansion compared with patients without diabetes, with reported differences of approximately 0.5-1.5 mm/year. Three cohorts further demonstrated that metformin use was independently associated with additional attenuation of AAA growth, with an adjusted reduction of approximately 0.3-0.4 mm/year.ConclusionAvailable clinical evidence consistently supports an inverse association between diabetes and AAA growth, with metformin emerging as a potential disease-modifying factor. These findings highlight metabolic modulation as a promising avenue for individualized surveillance strategies and future therapeutic investigation in AAA.