We read with interest the article by Kuivaniemi et al. on the pathogenesis of abdominal aortic aneurysms (AAAs).[Citation1] We agree that there is increasing knowledge in this area, including genetic and epigenetic risk factors, along with emerging inflammation markers.[Citation1] The major risk factors identified by the authors include smoking and positive family history, the latter becoming evident by the presence of familial AAAs.[Citation1]
We would like to point to the preventative role of diabetes mellitus (DM) in the development of AAAs. DM appears to be negatively related with the risk of AAAs formation [Citation2,Citation3] and expansion.[Citation4–Citation6] While present knowledge is far from definitive, increased matrix in the arterial wall, reduced concentrations and action of matrix metalloproteinases 2 and 9, as well as differences in the degree of inflammation and neovascularization are considered the main mechanisms mediating the reduced development and expansion of AAAs in DM.[Citation6,Citation7] A protective role of some pharmacological agents commonly used in DM (e.g., statins and metformin) is also being discussed, but results so far are rather contradictory.[Citation7]
In conclusion, we are progressing in our understanding of the pathogenesis of AAAs.[Citation1] Whether any relationship between DM and risk of AAA will yield useful clues for the prevention of expansion AAAs remains to be determined.
Financial & competing interests disclosure
I. Gouni-Berthold has received research grants from Bayer HealthCare; honoraria and travel expenses from Genzyme, MSD, Novartis, Novo Nordisk, Pfizer, Ipsen, Aegereon, Chiesi, Bristol-Myers Squibb, Amgen, Sanofi and Otsuka. N. Papanas has been an advisory board member of TrigoCare International; has participated in sponsored studies by Novo Nordisk and Novartis; has received honoraria as a speaker for Astra-Zeneca, Eli-Lilly, Novo Nordisk and Pfizer; and attended conferences sponsored by TrigoCare International, Novo Nordisk, Sanofi-Aventis and Pfizer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
Additional information
Notes on contributors
K. Pafili
I. Gouni-Berthold
N. Papanas
Related Research Data
References
- Kuivaniemi H, Ryer EJ, Elmore JR, et al. Understanding the pathogenesis of abdominal aortic aneurysms. Expert Rev Cardiovasc Ther. 2015;13(9):975–987.
- Lederle FA, Johnson GR, Wilson SE, et al. The aneurysm detection and management study screening program: validation cohort and final results. Aneurysm detection and management veterans affairs cooperative study investigators. Arch Intern Med. 2000;160(10): 1425–1430.
- Cornuz J, Sidoti Pinto C, Tevaearai H, et al. Risk factors for asymptomatic abdominal aortic aneurysm: systematic review and meta-analysis of population-based screening studies. Eur J Public Health. 2004;14(4): 343–349.
- Takagi H, Umemoto T. Diabetes and abdominal aortic aneurysm growth. Angiology. 2015; Epub ahead of print. DOI:10.1177/0003319715602414.
- Golledge J, Karan M, Moran CS, et al. Reduced expansion rate of abdominal aortic aneurysms in patients with diabetes may be related to aberrant monocyte-matrix interactions. Eur Heart J. 2008;29(5): 665–672.
- Thompson SG, Brown LC, Sweeting MJ, et al. Systematic review and meta-analysis of the growth and rupture rates of small abdominal aortic aneurysms: implications for surveillance intervals and their cost-effectiveness. Health Technol Assess. 2013;17(41): 1–118.
- Pafili K, Gouni-Berthold I, Papanas N, et al. Abdominal aortic aneurysms and diabetes mellitus. J Diabetes Complicat. 2015; Epub ahead of print. DOI:10.1016/j.jdiacomp.2015.08.011.