The efficacy of pharmacotherapy for decreasing the expansion rate of abdominal aortic aneurysms: A systematic review and meta-analysis

Abstract

Background: Pharmacotheraphy may represent a potential means to limit the expansion rate of abdominal aortic aneurysms (AAAs). Studies evaluating the efficacy of different pharmacological agents to slow down human AAA-expansion rates have been performed, but they have never been systematically reviewed or summarized. Methods and Findings: Two independent reviewers identified studies and selected randomized trials and prospective cohort studies comparing the growth rate of AAA in patients with pharmacotherapy vs no pharmacotherao. We extracted information on study interventions, baseline characteristics, methodological quality, and AAA growth rate differences (in mm/year). Fourteen prospective studies met eligibility criteria. Five cohort studies raised the possibility of benefit of beta-blockers [pooled growth rate difference: ∼0.62 mm/year, (95%Cl, ∼1.00 to ∼0.24)], but this was not confirmed in the beta-blocker RCTs [pooled RCT growth rate difference. ∼0.05 mm/year (∼0.16 to 0.051). Statins have been evaluated in two cohort studies that yield a pooled growth rate difference of ∼2.97 (∼583 to ∼0.11). Doxycline and been evaluated in two been evaluated in two RCTs that suggest possible benefit [pooled RCT growth rate diftrence: ∼1.32 mm/ year (∼2.89 to 0.25)]. Studies assessing NSAIDs, diuretics, calcium channel blockers and ACE inhibitors, meanwhile, did not find statistically significant differences. Conclusions: Beta-blockers do not appear to significantly reduce the growth rate of AAAs. Statins and other anti-inflammatory agents appear to hold promise for decreasing the expansion rate of AAA, but need further evaluation before definitive recommendations can be made. © 2008 Guessous et al.