We performed a systematic literature search and a meta-analysis to assess the association between diabetes mellitus (DM) and abdominal aortic aneurysm (AAA) growth. Databases including MEDLINE and EMBASE were searched through June 2015 using PubMed and OVID. For each study, data regarding AAA growth rates in both the DM and the non-DM groups were used to generate standardized mean differences (SMDs) and 95% confidence intervals (CIs). Our search identified 19 relevant studies including data on 9777 patients with AAA. Pooled analyses demonstrated a statistically significant slower growth rates in DM patients than in non-DM patients (unadjusted SMD, −0.32; 95% CI, −0.40 to −0.24; P < .00001; adjusted SMD, −0.29; 95% CI, −0.417 to −0.18; P < .00001). Despite possible publication bias in favor of DM based on funnel plot asymmetry, even adjustment of the asymmetry did not alter the beneficial effect of DM. In conclusion, on the basis of a meta-analysis of data on a total of 9777 patients (19 studies) identified through a systematic literature search, we confirmed the association of DM with slower growth rates of AAA.
TakagiHUmemotoT. A contemporary meta-analysis of the association of diabetes with abdominal aortic aneurysm. Int Angiol. 2015;34(4):375–382.
2.
SweetingMJThompsonSGBrownLCPowellJT; RESCAN Collaborators. Meta-analysis of individual patient data to examine factors affecting growth and rupture of small abdominal aortic aneurysms. Br J Surg. 2012;99(5):655–665.
3.
ThompsonSGBrownLCSweetingMJ. Systematic review and meta-analysis of the growth and rupture rates of small abdominal aortic aneurysms: implications for surveillance intervals and their cost-effectiveness. Health Technol Assess. 2013;17(41):1–118.
4.
LefebvreCManheimerEGlanvilleJ.Chapter 6: Searching for studies. In: HigginsJPGreenS, eds. Cochrane Handbook for Systematic Reviews of InterventionsVersion 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Web site. www.cochrane-handbook.org. Accessed July 1, 2015.
5.
BeggCBMazumdarM. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088–1101.
6.
EggerMDavey SmithGSchneiderMMinderC. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–634.
7.
DuvalSTweedieR. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56(2):455–463.
8.
Behr-RasmussenCGrøndalNBramsenMBThomsenMDLindholtJS. Mural thrombus and the progression of abdominal aortic aneurysms: a large population-based prospective cohort study. Eur J Vasc Endovasc Surg. 2014;48(3):301–307.
9.
BhakRHWiningerMJohnsonGR. Factors associated with small abdominal aortic aneurysm expansion rate. JAMA Surg. 2015;150(1):44–50.
10.
BradyARThompsonSGFowkesFGGreenhalghRMPowellJTSmall Aneurysm Trial ParticipantsUK. Abdominal aortic aneurysm expansion: risk factors and time intervals for surveillance. Circulation. 2004;110(1):16–21.
11.
CroninOLiuDBradshawB. Visceral adiposity is not associated with abdominal aortic aneurysm presence and growth. Vasc Med. 2014;19(4):272–280.
12.
De RangoPCaoPCieriE. Comparison of surveillance vs. Aortic Endografting for Small Aneurysm Repair (CAESAR) investigators group. Effects of diabetes on small aortic aneurysms under surveillance according to a subgroup analysis from a randomized trial. J Vasc Surg. 2012;56(6):1555–1563.
13.
FergusonCDClancyPBourkeB. Association of statin prescription with small abdominal aortic aneurysm progression. Am Heart J. 2010;159(2):307–313.
14.
GolledgeJKaranMMoranCS. Reduced expansion rate of abdominal aortic aneurysms in patients with diabetes may be related to aberrant monocyte-matrix interactions. Eur Heart J. 2008;29(5):665–672.
15.
KarlssonLGnarpeJBergqvistDLindbäckJPärssonH. The effect of azithromycin and Chlamydophilia pneumonia infection on expansion of small abdominal aortic aneurysms--a prospective randomized double-blind trial. J Vasc Surg. 2009;50(1):23–29.
16.
LindholtJSJuulSFastingHHennebergEW. Screening for abdominal aortic aneurysms: single centre randomised controlled trial. BMJ. 2005;330(7494):750.
17.
NormanPEJamrozikKLawrence-BrownMM. Population based randomised controlled trial on impact of screening on mortality from abdominal aortic aneurysm. BMJ. 2004;329(7477):1259.
18.
OurielKClairDGKentKCZarinsCK, Positive Impact of Endovascular Options for treating Aneurysms Early (PIVOTAL) Investigators. Endovascular repair compared with surveillance for patients with small abdominal aortic aneurysms. J Vasc Surg. 2010;51(5):1081–1087.
19.
Propranolol Aneurysm Trial Investigators. Propranolol for small abdominal aortic aneurysms: results of a randomized trial. J Vasc Surg. 2002;35(1):72–79.
20.
SchlösserFJTangelderMJVerhagenHJ. Growth predictors and prognosis of small abdominal aortic aneurysms. J Vasc Surg. 2008;47(6):1127–1133.
21.
SchoutenOvan LaanenJHBoersmaE. Statins are associated with a reduced infrarenal abdominal aortic aneurysm growth. Eur J Vasc Endovasc Surg. 2006;32(1):21–26.
22.
SolbergSSinghKWilsgaardTJacobsenBK. Increased growth rate of abdominal aortic aneurysms in women. The Tromsø study. Eur J Vasc Endovasc Surg. 2005;29(2):145–149.
23.
ThompsonACooperJAFabriciusMHumphriesSEAshtonHAHafezH. An analysis of drug modulation of abdominal aortic aneurysm growth through 25 years of surveillance. J Vasc Surg. 2010;52(1):55–61.e2.
24.
VardulakiKAPrevostTCWalkerNM. Growth rates and risk of rupture of abdominal aortic aneurysms. Br J Surg. 1998;85(12):1674–1680.
25.
Vega de CénigaMGómezREstalloLRodríguezLBaquerMBarbaA. Growth rate and associated factors in small abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2006;31(3):231–236.
26.
DeeksJJHigginsJPAltmanDG eds. Chapter 9: Analysing data and undertaking meta-analyses. In: HigginsJPGreenS eds. Cochrane Handbook for Systematic Reviews of InterventionsVersion 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Web site. www.cochrane-handbook.org. Accessed July 1, 2015.
27.
ChinnS. A simple method for converting an odds ratio to effect size for use in meta-analysis. Stat Med. 2000;19(22):3127–3131.
28.
ShantikumarSAjjanRPorterKEScottDJ. Diabetes and the abdominal aortic aneurysm. Eur J Vasc Endovasc Surg. 2010;39(2):200–207.
29.
De RangoPFarchioniLFiorucciBLentiM. Diabetes and abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2014;47(3):243–261.
30.
JonesSCSaundersHJPollockCA. High glucose increases growth and collagen synthesis in cultured human tubulointerstitial cells. Diabet Med. 1999;16(11):932–938.
31.
Portik-DobosVAnstadtMPHutchinsonJBannanMErgulA. Evidence for a matrix metalloproteinase induction/activation system in arterial vasculature and decreased synthesis and activity in diabetes. Evidence for a matrix metalloproteinase induction/activation system in arterial vasculature and decreased synthesis and activity in diabetes. Diabetes. 2002;51(10):3063–3068.
32.
SakataNMengJTakebayashiS. Effects of advanced glycation end products on the proliferation and fibronectin production of smooth muscle cells. J Atheroscler Thromb. 2000;7(3):169–176.
33.
AronsonD. Cross-linking of glycated collagen in the pathogenesis of arterial and myocardial stiffening of aging and diabetes. J Hypertens. 2003;21(1):3–12.
34.
NormanPEDavisTMLeMTGolledgeJ. Matrix biology of abdominal aortic aneurysms in diabetes: mechanisms underlying the negative association. Connect Tissue Res. 2007;48(3):125–131.
35.
CerielloAIhnatMAThorpeJE. Clinical review 2: The “metabolic memory”: is more than just tight glucose control necessary to prevent diabetic complications?J Clin Endocrinol Metab. 2009;94(2):410–415.
36.
MadiHARichesKWarburtonPO'ReganDJTurnerNAPorterKE. Inherent differences in morphology, proliferation, and migration in saphenous vein smooth muscle cells cultured from nondiabetic and Type 2 diabetic patients. Am J Physiol Cell Physiol. 2009;297(5):C1307–C1317.
37.
van HeerebeekLHamdaniNHandokoML. Diastolic stiffness of the failing diabetic heart: importance of fibrosis, advanced glycation end products, and myocyte resting tension. Circulation. 2008;117(1):43–51.
38.
AhimastosAANatoliAKLawlerABlomberyPAKingwellBA. Ramipril reduces large-artery stiffness in peripheral arterial disease and promotes elastogenic remodeling in cell culture. Hypertension. 2005;45(6):1194–1199.
39.
EvansJPowellJTSchwalbeELoftusIMThompsonMM. Simvastatin attenuates the activity of matrix metalloprotease-9 in aneurysmal aortic tissue. Eur J Vasc Endovasc Surg. 2007;34(3):302–303.
40.
LiLMamputuJCWiernspergerNRenierG. Signaling pathways involved in human vascular smooth muscle cell proliferation and matrix metalloproteinase-2 expression induced by leptin: inhibitory effect of metformin. Diabetes. 2005;54(7):2227–2234.
41.
HaffnerSMGreenbergASWestonWMChenHWilliamsKFreedMI. Effect of rosiglitazone treatment on nontraditional markers of cardiovascular disease in patients with type 2 diabetes mellitus. Circulation. 2002;106(6):679–684.
42.
TouatZOllivierVDaiJ. Renewal of mural thrombus releases plasma markers and is involved in aortic abdominal aneurysm evolution. Am J Pathol. 2006;168(3):1022–1030.
43.
HouardXRouzetFTouatZ. Topology of the fibrinolytic system within the mural thrombus of human abdominal aortic aneurysms. J Pathol. 2007;212(1):20–28.
44.
DunnEJAriënsRAGrantPJ. The influence of type 2 diabetes on fibrin structure and function. Diabetologia. 2005;48(6):1198–1206.
45.
FestaAD'AgostinoRJrMykkänenL. Relative contribution of insulin and its precursors to fibrinogen and PAI-1 in a large population with different states of glucose tolerance. The Insulin Resistance Atherosclerosis Study (IRAS). Arterioscler Thromb Vasc Biol. 1999;19(3):562–568.
LederleFALarsonJCMargolisKL. Women’s Health Initiative Cohort Study. Abdominal aortic aneurysm events in the women’s health initiative: cohort study. BMJ. 2008;337: a1724.
50.
YeapBBChubbSAMcCaulKA. Associations of IGF1 and its binding proteins with abdominal aortic aneurysm and aortic diameter in older men. Eur J Endocrinol. 2012;166(2):191–197.
51.
NakayamaAMoritaHMiyataT. Inverse association between the existence of coronary artery disease and progression of abdominal aortic aneurysm. Atherosclerosis. 2012;222(1):278–283.
52.
ParrAMcCannMBradshawBShahzadAButtnerPGolledgeJ. Thrombus volume is associated with cardiovascular events and aneurysm growth in patients who have abdominal aortic aneurysms. J Vasc Surg. 2011;53(1):28–35.
53.
StewartLATierneyJFClarkeM.Chapter 19: Reviews of individual patient data. In: HigginsJPGreenS, eds. Cochrane Handbook for Systematic Reviews of InterventionsVersion 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Web site. www.cochrane-handbook.org. Accessed July 1, 2015.
54.
StewartLATierneyJF. To IPD or not to IPD? Advantages and disadvantages of systematic reviews using individual patient data. Eval Health Prof. 2002;25(1):76–97.
