We appreciate the interest that our article [Citation1] on the pathogenesis of abdominal aortic aneurysms (AAAs) has created. In our review, we concentrated on studies published in the past 5 years related to genetic and epigenetic risk factors identified in genome-wide screens for AAA, studies using transcriptomics and proteomics, as well as studies on differences between the thoracic aortic aneurysms and AAAs. The review focused on recent advances and due to the limitations on the number of references, we were not able to cover all aspects of AAA pathobiology.
We agree with Pafili et al. [Citation2] and authors of previous publications (see [Citation3–Citation5]) that diabetes mellitus (DM) has an intriguing inverse correlation with the development and growth of AAAs. In fact, we have also published a study confirming the inverse correlation between DM and AAA diagnoses based on diagnostic (ICD-9) and procedure codes using clinical data extracted from electronic medical records.[Citation6] There is, however, a lack of pathobiological studies that elucidate this phenomenon in the most recent literature. Although the risk for AAA is lower among diabetic patients, the relationship between AAA and DM is more complicated as there is evidence showing significantly increased operative mortality in diabetic patients undergoing AAA repair. Specifically, a recent systematic review of 14 studies, that included 19,288 diabetic and 193,777 controls receiving open or endovascular repair, demonstrated a significantly increased operative mortality for diabetic patients.[Citation5] Similarly, diabetic patients also demonstrated a lower long-term survival, possibly due to an increased rate of surgical complications.[Citation5] Further studies are, therefore, urgently needed. They are of great importance not only for understanding AAA pathobiology, but also for that of intracranial aneurysms,[Citation7] and thoracic aortic aneurysms and dissections,[Citation8] which are also inversely correlated with the presence of DM.
Financial & competing interests disclosure
The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
References
- Kuivaniemi H, Ryer EJ, Elmore JR, et al. Understanding the pathogenesis of abdominal aortic aneurysms. Expert Rev Cardiovasc Ther. 2015;13:975–987.
- Pafili K, Gouni-Berthold I, Papanas N. Abdominal aortic aneurysms: do not underestimate the role of diabetes. Expert Rev Cardiovasc Ther. 2015;13:12.
- Pafili K, Gouni-Berthold I, Papanas N, et al. Abdominal aortic aneurysms and diabetes mellitus. J Diabetes Complicat. 2015; August 19 Epub ahead of print. DOI:10.1016/j.jdiacomp.2015.08.011.
- Lederle FA. The strange relationship between diabetes and abdominal aortic aneuryms. Eur J Vasc Endovasc Surg. 2012;43:254–256.
- De Rango P, Farchioni L, Fiorucci B, et al. Diabetes and abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2014;47:243–261.
- Smelser DT, Tromp G, Elmore JR, et al. Population risk factor estimates for abdominal aortic aneurysm from electronic medical records: a case control study. BMC Cardiovasc Disord. 2014;14:174.
- Tromp G, Weinsheimer S, Ronkainen A, et al. Molecular basis and genetic predisposition to intracranial aneurysm. Ann Med. 2014;46:597–606.
- Prakash SK, Pedroza C, Khalil YA, et al. Diabetes and reduced risk for thoracic aortic aneurysms and dissections: a nationwide case-control study. J Am Heart Assoc. 2012;1:e000323.