Risk factors for abdominal aortic aneurysm in patients with diabetes

Objective: Although diabetes has been shown to be negatively associated with development of abdominal aortic aneurysm (AAA), patients with diabetes may still develop aneurysms. In this study, we examined risk factors for the development of AAA in patients with diabetes. Methods: Adults >50 years of age with diabetes who underwent health screening between 2009 and 2012 were followed for incident AAA until December 31, 2019. Cox proportional hazard regression models were used to calculate multivariate hazard ratios (HRs) and 95% confidence intervals (CIs) for risk factors associated with AAA. Results: Among 1,913,066 participants (55.3% men), 6996 AAA cases were identified during a mean follow-up of 7.7 years. Increased AAA risk was observed for age ≥65 years (HR, 2.69; 95% CI, 2.55-2.83), men (HR, 1.81; 95% CI, 1.69-1.94), smoking (former smoker ≥20 pack-years [PY]; HR, 1.75; 95% CI, 1.61-1.89; current smoker <20 PY; HR, 1.76; 95% CI, 1.59-1.94; current smoker ≥20 PY; HR, 2.40; 95% CI, 2.23-2.59), abdominal obesity (HR, 1.30; 95% CI, 1.23-1.38), and comorbidities, including hypertension (HR, 1.63; 95% CI, 1.53-1.73), dyslipidemia (HR, 1.35; 95% CI, 1.29-1.42), chronic kidney disease (HR, 1.52; 95% CI, 1.44-1.61), and cardiovascular disease (HR, 1.71; 95% CI, 1.58-1.86). Heavy (HR, 0.67; 95% CI, 0.61-0.74) and mild alcohol consumption (HR, 0.78; 95% CI, 0.74-0.83), overweight (HR, 0.87; 95% CI, 0.81-0.93) and obesity (HR, 0.81; 95% CI, 0.75-0.87), longer diabetes duration (≥5 years: HR, 0.74; 95% CI, 0.70-0.78), and using three or more oral hypoglycemic agents (OHA) (HR, 0.84; 95% CI, 0.79-0.90) were associated with decreased AAA risk, whereas insulin use was associated with a marginally increased risk (HR, 1.09; 95% CI, 1.00-1.18). Among the OHAs, metformin (HR, 0.95; 95% CI, 0.90-1.00), thiazolidinediones (HR, 0.87; 95% CI, 0.79-0.97), and sulfonylureas (HR, 0.88; 95% CI, 0.83-0.93) were associated with a decreased risk of AAA. Conclusions: Although diabetes is associated with decreased AAA risk, those with comorbid cardiometabolic diseases, abdominal obesity, and a smoking history should be aware of an increased AAA risk. Further studies are warranted to verify the potential use of OHAs for decreasing AAA risk.