Targeting Lipids May Improve Outcomes of Abdominal Aortic Aneurysm

Risk factors for abdominal aortic aneurysm (AAA) are largely unknown, but a new study in JAMA Cardiology has found that patients with AAA have a high burden of genetically determined dyslipidemia.

AAA is a cardiovascular disease that results in 4500 deaths annually in the United States due to AAA rupture. Currently, 45,000 operations are performed yearly, but these surgeries contribute to 1400 deaths annually.

Because risk factors for AAA have been unknown, the development of nonsurgical treatments to alter the natural history of the disease has been lacking. However, the new findings of this study indicate that targeting lipids may improve long-term outcomes.

“From a clinical point of view, it is important to understand the role of lipids in AAA, especially considering the excess cardiovascular risks in patients with AAA and the recent publications showing low prevalence of lowering levels of LDL-C [low-density lipoprotein cholesterol] in patients with AAA,” the authors wrote.

In the study, the authors investigated the association of genetic risk scores for lipid trains with AAA in nearly 5000 cases and approximately 48,000 controls in Australia, Iceland, the Netherlands, New Zealand, the United Kingdom, and the United States. Data was collected between January 9, 2015, and January 4, 2016.

Using mendelian randomization, the authors found that LDL-C, high-density lipoprotein cholesterol, and triglycerides played important roles in the etiology of AAA. As a result, targeting lipids through medication in patients with small AAAs may “be justified,” the authors wrote. They added that these patients should be considered for relevant clinical trials of novel medications.

“Consideration should be given to measures aimed at targeting lipids to reduce risk of AAA, using established and emerging therapies,” the authors concluded.

Some of the limitations of the study included not having data sets to evaluate AAA progression and the use of summary-level data, which hampers more refined analyses.