Associations of antidiabetic medications with abdominal aortic aneurysm growth and clinical outcomes: A systematic review and meta-analysis.
Yoonjung Park, Soyoung Kang, Hyun Woo Lee et al.
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In 30 seconds
This systematic review and meta-analysis assessed associations between antidiabetic medications and abdominal aortic aneurysm (AAA) growth or related events. It included 13 studies comprising 15 cohorts and 150,630 participants. Metformin use was associated with slower AAA growth (MD, -0.65 mm/year; 95% CI, -0.97 to -0.33) and fewer AAA-related events (OR, 0.63; 95% CI, 0.41-0.95). Sulfonylureas were also associated with reduced growth and events. Most included studies were observational, so the findings do not establish that these medications cause better AAA outcomes.
Key findings
- Metformin was associated with slower AAA growth (MD, -0.65 mm/year; 95% CI, -0.97 to -0.33).
- Metformin use was associated with fewer AAA-related events (OR, 0.63; 95% CI, 0.41-0.95).
- Sulfonylureas were associated with reduced AAA growth (MD, -0.35 mm/year; 95% CI, -0.52 to -0.18) and events (OR, 0.63; 95% CI, 0.52-0.77).
- Metformin was not significantly associated with postoperative mortality (HR, 0.86; 95% CI, 0.65-1.13).
Why it matters
AAA progression and related events are clinically important outcomes, and this synthesis identifies associations with two commonly used glucose-lowering drug classes. The results may inform interpretation of observational data and help frame research questions, but they do not show that prescribing these agents to alter AAA outcomes is beneficial. Evidence for other therapies remains limited.
What to keep in mind
Most studies were observational and had moderate risk of bias, limiting causal inference. The review concludes that randomized trials are needed to assess drug-specific associations and outcomes across patient groups.