SAIMSARA Journal · Apr 12, 2026
Medical Management of Abdominal Aortic Aneurysm: Scoping Review with ☸SAIMSARA
By SAIMSARA
The aim of this review is to synthesize current evidence regarding the impact of various pharmacological agents on AAA formation, growth rates, and clinical outcomes, including mortality and perioperative complications, across animal models and human populations. The review utilises 90 original studies with 934696 total participants (topic deduplicated ΣN). This evidence map indicates that the clearest and most consistent medication-related signal in abdominal aortic aneurysm care is improved long-term survival with statin and antiplatelet therapy, including hazard ratios around 0.5-0.6 in vascular and aneurysm repair populations and an odds ratio of 0.50 for reduced large aneurysm rupture with statin use. The mapped literature also suggests that disease-modifying effects on aneurysm growth remain less certain: metformin showed slower enlargement in observational cohorts, including about -0.23 mm/year in one veteran study, whereas a randomized trial in non-diabetic patients found no significant diameter benefit over 18 months. Additional signals support a role for targeted perioperative and secondary prevention strategies, such as avoiding routine dual antiplatelet escalation after endovascular aneurysm repair because bleeding risk increased (hazard ratio 1.20) without clear outcome gain, while adherence to preventive therapy after diagnosis remained incomplete at roughly 57-60% among baseline non-users. Mechanistic animal studies further highlight vascular smooth muscle cell senescence and inflammasome pathways as plausible therapeutic targets, but translation to human benefit is still limited by heterogeneous and largely observational clinical evidence. In practice, the current map supports aggressive cardiovascular risk reduction as the most actionable medication strategy in abdominal aortic aneurysm, while future research should prioritize adequately powered randomized trials and standardized longitudinal studies to clarify which agents truly slow aneurysm growth or reduce aneurysm-specific events.