Abdominal aortic aneurysm medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Aarti Narayan, M.B.B.S [3]; Vishnu Vardhan Serla M.B.B.S. [4] Ramyar Ghandriz MD[5]
Overview
Risk factor modification including smoking cessation, management of hypertension, and lipid lowering are essential in reducing the risk of development and the rate of progression of abdominal aortic aneurysms.
Risk Factor Modification
- Smoking contributes to the development and rupture of aneurysms, therefore smoking cessation should be encouraged in patients with an abdominal aortic aneurysm and in individuals with a family history of abdominal aortic aneurysm.
- Risk factors for atherosclerosis development and progression such as hypertension and hyperlipidemia should be controlled.
Medical Therapy
ACE Inhibitors
- ACE inhibitors may be administered to control hypertension in patients with an abdominal aortic aneurysm.
Statins
- Statins may be administered to control hyperlipidemia, which may reduce mortality in patients who have undergone an abdominal aortic aneurysm repair.[1]
Beta Blockers
- Beta Blockers may have a beneficial effect on the expansion of aneurysms because of their ability to reduce blood pressure. They are used routinely in patients with abdominal aortic aneurysm who are followed non-operatively.[2]
- Reduce aortic complications in patients with Marfan syndrome.
- Slow progression of AAAs in hypertensive patients.
- In the absence of other indications for beta blockers, the evidence is insufficient to recommend using them routinely for the sole purpose of slowing atherosclerotic aneurysm growth.
Aspirin
The beneficial effects of aspirin on prevention of CAD and PAD among patients at low to intermediate risk of bleeding likely outweighs its bleeding risk.
2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines (DO NOT EDIT)
Treatment of AAA with Statins
| Class I |
| 1. In patients with AAA and evidence of aortic atherosclerosis, statin therapy at moderate or high intensity is recommended. (Level of Evidence: B-NR) |
| Class IIb |
| "1. In patients with AAA but no evidence of atherosclerosis, statin therapy may be considered . (Level of Evidence: C-LD)" |
Management of Patients With Peripheral Artery Disease
- Management of Patients With Peripheral Artery Disease (Compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations) : A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[3]
| Class I |
| "1.Perioperative administration of beta-adrenergic blocking agents, in the absence of contraindications, is indicated to reduce the risk of adverse cardiac events and mortality in patients with coronary artery disease undergoing surgical repair of atherosclerotic aortic aneurysms.(Level of Evidence: A)" |
| Class IIb |
| "1.Beta-adrenergic blocking agents may be considered to reduce the rate of aneurysm expansion in patients with aortic aneurysms. (Level of Evidence: B)" |
References
- ↑ Kalyanasundaram A, Elmore JR, Manazer JR; et al. (2006). "Simvastatin suppresses experimental aortic aneurysm expansion". Journal of Vascular Surgery. 43 (1): 117–24. doi:10.1016/j.jvs.2005.08.007. PMID 16414398. Unknown parameter
|month=ignored (help) - ↑ Hirsch AT, Haskal ZJ, Hertzer NR; et al. (2006). "ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation". Circulation. 113 (11): e463–654. doi:10.1161/CIRCULATIONAHA.106.174526. PMID 16549646. Unknown parameter
|month=ignored (help) - ↑ Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss L; et al. (2013). "Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. 61 (14): 1555–70. doi:10.1016/j.jacc.2013.01.004. PMC 4492473. PMID 23473760.