Currently, there are no drugs to treat abdominal aortic aneurysms (AAA) outside those indicated as secondary prevention drugs.
What this study shows is that diabetic patients treated with metformin had lower AAA incidence than diabetic patients treated without metformin, and even lower incidence than non- diabetic patients, as if metformin per se were a protective factor beyond diabetes. This undoubtedly calls for randomized studies with small AAA and evolution follow up.
The present observational and prospective study carried out in Australia included asymptomatic patients with unrepaired AAA of any diameter over 30 mm.
Read also: Several Features Define a Hostile Neck in AAA patients, but Only One Makes the Difference.
Primary end point was the need to repair AAA or AAA related mortality. The association between metformin and AAA related events was assessed using Kaplan Meier analysis and Cox proportional hazard analysis.
It included 1080 patients with an initial average diameter of 46.1 mm, followed up for mean 2.5 years.
Patients with a diabetes diagnosis in treatment with metformin presented lower AAA related events than non-diabetic patients (adjusted HR 0.63, CI 95% 0.44 to 0.93), while diabetics without metformin did not (adjusted HR 1.15, CI 95% CI 0.83 to 1.59).
Read also: Risk of Colonic Ischemia after Abdominal Aortic Aneurysm Repair.
Findings were similar when looking at patients with ≤50 mm initial diameters.
Conclusion
These findings set grounds for a future randomized study to determine the clinical importance of metformin in AAA patients, regardless diameter or the presence or absence of diabetes.
Original title: Metformin Prescription is Associated with a Reduction in the Combined Incidence of Surgical Repair and Rupture Related Mortality in Patients with Abdominal Aortic Aneurysm.
Reference: Jonathan Golledge et al. Eur J Vasc Endovasc Surg. 2019 Jan;57(1):94-101.
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