Does diabetes affect risk for abdominal aortic aneurysm rupture?

  • Kristensen KL & al.
  • Eur J Vasc Endovasc Surg
  • 3 Apr 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Diabetes is not protective against ruptured (R) abdominal aortic aneurysm (AAA).
  • Diabetes is also not linked to increased 30-day mortality post-RAAA.

Why this matters

  • Previous studies have shown a paradoxical protective effect of diabetes on AAA development and progression, but its effect on RAAA and post-RAAA mortality was not known.

Study design

  • Register-based case-control study of 5395 patients age ≥50 years with RAAA.
  • Patients were matched 1:1 for age, sex, and diabetes diagnosis year with those undergoing elective AAA repair.
  • 6.7% with RAAA and 8.0% undergoing repair had diabetes.
  • Funding: University of Southern Denmark; Danish Diabetes Academy funded by The Novo Nordisk Foundation; Odense University Hospital.

Key results

  • With a large AAA, RAAA and diabetes were inversely associated:
    • Crude OR: 0.82 (95% CI, 0.71-0.95).
    • Association was lost after adjustment: aOR, 0.97 (95% CI, 0.83-1.14).
  • Of the 3079 (57.1%) who underwent surgery, 94% received outright repair and 6% exploratory laparotomy.
  • Overall 30-day mortality:
    • 58% among those with RAAA.
    • 34.8% in repair group.
  • For diabetes vs no diabetes, for 30-day mortality:
    • Crude HR: 1.06 (95% CI, 0.93-1.22).
    • After adjustment for index year, male sex, and age: HR, 1.11 (95% CI, 0.97-1.28).

Limitations

  • Matching not possible for all cases.
  • Possible misclassification.