Statins and Small Abdominal Aortic Aneurysms: Unexpected Aid?

Courtesy of Dr. Juan Manuel Pérez.

Abdominal aortic aneurysms (AAA) entail high morbimortality in case of rupture, and at present, no approved drug therapies have been shown to slow down their progression. Observational studies have suggested statins may slow down AAA growth rate and associated events, though no randomized studies have yet confirmed this.

This study looked at the link between statin use and dosage with AAA growth rate and event occurrence in the context of two Danish population-based screening trials: the VIVA (2008–2011) and the DANCAVAS (2014–2018). The primary outcome was AAA growth rate. Secondary end points included need for repair, rupture and the combined end point of repair, rupture and all-cause mortality. 

998 men with 30 to 55 mm AAA were assessed. Mean patient age was 69.5 (IQR 67–72), and mean AAA diameter was 35.4 mm. 89 % of patients had received statins, and were classified according to drug daily dose (DDD): 23.8 % received a low intensity dose (less than 1 DDD), 48.5 % a moderate intensity dose (1 to 2 DDD), and 16.7 % a high intensity dose (2 or more DDD). Patients were followed up for 5 years, or until there was an event.

The use of statins was associated to dose-dependent slower AAA growth rate: for every additional DDD, growth rate was reduced by 0.22 mm/year (p = 0.009), with an observed maximum of −0.88 mm/year for doses equivalent to 80 mg atorvastatin (4 DDD). Participants receiving high intensity statins presented significantly lower growth rates (1.5 ± 2.1 mm/year vs. 2.4 ± 2.3 mm/year in those on lower doses; p = 0.001).

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Also, twice as high cumulative statin dose was associated with 18 % reduction in risk of surgery (HR 0.82) and 17 % in the combined risk of surgery, rupture or death (HR 0.83). This effect started to show after 2.5 years. Subgroup analysis showed the benefit was more pronounced in patients with asymptomatic cardiovascular disease. 

Conclusion

This prospective study suggests the use of statins, especially at high doses, is associated with a significant reduction in AAA growth and risk of major adverse events such as surgery, rupture and death. Further research is required to confirm these findings in other populations and to explore underlying mechanisms. 

Original Title: Association of Statin Treatment and Dose With the Clinical Course of Small Abdominal Aortic Aneurysms in Men: A 5-Year Prospective Cohort Study From 2 Population-Based Screening Trials.

Reference: Joachim S. Skovbo et al. Circulation. 2025;152:00–00. DOI: 10.1161/CIRCULATIONAHA.125.074544.