Lipids and abdominal aortic aneurysm: from pathophysiology to therapy. A call to action from the Italian Society for the Study of Atherosclerosis and the Italian Society for Angiology and Vascular Medicine.
Rossella Marcucci, Marco Bucci, Walter Ageno et al.
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In 30 seconds
This consensus statement and systematic review from SISA and SIAPAV assessed evidence on lipoproteins and lipid-regulating proteins in abdominal aortic aneurysm (AAA), drawing on clinical, experimental, genetic, and omic studies identified through a systematic PubMed/MEDLINE search covering 2013–2025. Epidemiological, genome-wide association, and Mendelian randomisation evidence supports a causal role for LDL-cholesterol, triglyceride-rich lipoproteins, and lipoprotein(a) in AAA development and progression. HDL dysfunction and proteins including PCSK9, ANGPTL3, and apoC-III may also contribute. However, no dedicated randomised clinical trials have shown that lipid-lowering therapy modifies AAA progression.
Key findings
- Evidence from epidemiological, genetic, and Mendelian randomisation studies supports causal roles for LDL-cholesterol, triglyceride-rich lipoproteins, and lipoprotein(a) in AAA development and progression.
- HDL dysfunction, rather than low HDL-cholesterol alone, is implicated in vascular inflammation and extracellular matrix degradation.
- PCSK9, ANGPTL3, and apoC-III may contribute to aneurysm formation through lipid-dependent and lipid-independent inflammatory pathways.
- No dedicated randomised clinical trials have demonstrated that lipid-lowering therapies modify AAA progression.
Why it matters
The review brings together evidence that lipid pathways may be relevant to AAA biology beyond their established role in cardiovascular risk. This could help guide biomarker research and identify candidate therapeutic targets, while distinguishing mechanistic and genetic support from demonstrated clinical benefit. Whether lipid-targeted interventions change aneurysm growth or rupture risk remains unresolved.
What to keep in mind
The evidence synthesis reports no dedicated randomised clinical trials demonstrating an effect of lipid-lowering therapies on AAA progression.