Association of metformin use with abdominal aortic aneurysm: A systematic review and meta-analysis

Abstract

Background Abdominal aortic aneurysm (AAA) is a cardiovascular disease characterized by a high mortality rate when ruptured. Some studies suggest a potential inverse correlation between AAA and diabetes patients, especially those undergoing metformin treatment. However, this relationship remains unclear. This paper offers a systematic review and meta-analysis with the objective of clarifying the influence of metformin on AAA. Methods A search for relevant articles was performed across multiple databases including PubMed, ScienceDirect, Cochrane and Scopus. The focus was on studies that examined the comparative effects of metformin and non-metformin treatments on AAA patients. Data from appropriate studies were consolidated to estimate the effects. Our study encompassed 11 articles, comprising 13 cohorts that compared metformin ( n = 32,250) with a control group ( n = 116,339). Results The random effects meta-analysis revealed that metformin was associated with a slower growth rate (weighted mean difference (WMD) −0.86 mm; 95% CI: −1.21 to −0.52; p < 0.01; I2: 81.4%) and fewer AAA-related events (OR: 0.54; 95% CI: 0.34 to 0.86; p = 0.01; I2: 60.9%). The findings suggest that metformin may be linked to a reduced risk of aortic aneurysm. A meta-regression analysis indicated that the association between metformin and AAA growth was significantly influenced by male gender ( p = 0.027), but not by age ( p = 0.801), hypertension ( p = 0.256), DM ( p = 0.689), smoking history ( p = 0.786), use of lipid-lowering agents ( p = 0.715), or baseline diameter ( p = 0.291). Conclusion These results hint at a potential role for metformin in limiting annual AAA growth, AAA-related events, and the risk of AAA.