Cardiovascular morbidity, mortality and risk management in patients with abdominal aortic aneurysms

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Introduction: Cardiovascular events are the most common cause of mortality in patients with an abdominal aortic aneurysm (AAA) regardless of intervention to treat the aneurysm. This systematic review aims to quantify the risk of cardiovascular morbidity and mortality in all patients with AAA before and after repair. Methods: The review was conducted in line with the framework of Cochrane reviews and Standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases were searched for studies that published cardiovascular mortality and/or morbidity rates of people diagnosed with an AAA. Studies only discussing AAA-related deaths or papers looking at aneurysms caused by connective tissue disorders, thoracic aortic aneurysms or ectatic abdominal aortas were excluded. Data on patient demographics, prevalence of comorbidities and medical therapy were extracted where possible. Results: 17 studies with 78,500 patients were included. The weighted mean prevalence of antiplatelet therapy and lipid-lowering therapy prescriptions was 62.8% and 60.2%, respectively. Pooled mortality rates secondary to myocardial infarction were 5.7% at 5 years with a 2.87% risk of death per year and 11.4% at 10 years with a 1.48% risk of death per year. The pooled mortality rate secondary to an acute cerebrovascular event was 1.9% at 5 years with a 0.38% risk of death per year. The pooled overall cardiovascular mortality rate was 14.5% at 5 years with a 5.43% risk of death per year. Conclusions: This review demonstrates suboptimal prescription of best medical therapy alongside a significant incidence of cardiovascular morbidity and mortality in patients with AAAs. Greater emphasis should be placed on optimisation of antiplatelet therapy and lipid-lowering therapy in primary care and vascular surgery services with the aim of improving cardiovascular-related outcomes for this patient cohort.