Abdominal aortic aneurysm: pathogenesis and implications for management.
Abdominal aortic aneurysm (AAA) affects approximately 5% of elderly men and is responsible for a significant number of deaths in Western Countries. At present surgery by open or endovascular means is the only widely used therapy for this condition. In this review we examine the risk factors, serum, and genetic associations of AAA. Epidemiology studies suggest that smoking cessation and control of cholesterol and blood pressure should reduce the number of patients developing AAA. Natural history studies suggest that smoking cessation should reduce the rate of progression of AAA. Clear level 1 evidence for drug treatments of AAA are presently lacking; however, animal and human in vitro studies suggest that medication targeted at reducing inflammation and proteolysis are most likely to be beneficial, with limited data to support the use of statins, Angiotensin II inhibitors, and macrolides. Work has commenced in understanding which patients, identified by clinical, serum, and genotype, are more at risk of AAA progression and thus should be selected out for aggressive treatment. Well designed large multicenter randomized controlled trials are required to examine the medical treatment of AAA.
Golledge
Jonathan
J
The Vascular Biology Unit, School of Medicine, James Cook University, Townsville, Queensland 4811, Australia. Jonathan.Golledge@jcu.edu.au
Muller
Juanita
J
Daugherty
Alan
A
Norman
Paul
P
D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000818:Animals; D017544:Aortic Aneurysm, Abdominal / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007249:Inflammation / Q000150:complications / Q000188:drug therapy; D018942:Macrolides / Q000627:therapeutic use; D012307:Risk Factors; D016540:Smoking Cessation
D047228:Angiotensin II Type 1 Receptor Blockers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D018942:Macrolides