LAUSR

Diabetes-Related Factors and Abdominal Aortic Aneurysm (AAA) Events: The Atherosclerotic Risk in Communities Study Kubota Y, Folsom AR, Pankow JS, Wagenknecht LE, Tang W. Ann Epidemiol 2018;28:102-6. Study design: Longitudinal study of patients entered at baseline between 1987 and 1989 in the Atherosclerosis Risk in Communities (ARIC) study from four U.S. communities in Mississippi, Maryland, Minnesota, and North Carolina. Key findings: The study followed 13,736 men and women aged 45 to 64 for abdominal aortic aneurysm (AAA) occurrence through 2011. Although fasting serum glucose and plasma leptin were inversely associated with AAA risk, patients with metabolic syndrome had increased occurrence of AAA. Conclusion: Diabetes, fasting glucose, and plasma leptin were inversely associated with risk of AAA, but metabolic syndrome was associated with increased risk of AAA. Commentary: Although atherosclerosis, male sex, hypertension, dyslipidemia, and smoking have been identified as risk factors for AAA, diabetes has been shown to be inversely associated with AAA occurrence (this is a common vascular board question!). Hyperglycemia is associated with increased collagen synthesis, elevated formation of glycation end products, and decreased matrix metalloproteinases, all of which cause increased arterial stiffness by promoting cross-links between proteins such as elastin and collagen in the vessel wall and thus decreased risk of developing AAA. Metabolic syndrome is a precursor to diabetes in many people but nonetheless was associated with increased risk of AAA due to nonglucose metabolic syndrome components. This is the first study to show a positive association between metabolic syndrome and AAA.