Drug-induced aortic aneurysms, ruptures and dissections

Abstract

Both prescription drugs and illicit substances have been associated with the formation of aortic aneurysms, ruptures of aortic aneurysms, and acute aortic dissections. Most of the clinical information exists as single case reports and case series, but causal relationships have for many drug groups been substantiated on the basis of the known mechanisms of action of the drugs as well as from experimental studies in animals. For abdominal aneurysms, the most important etiologic factors include systemic hypertension, hyperlipidemia and atherosclerosis. In theory, all drugs having a negative impact of one or more of these factors might increase the risk of aortic aneurysms. On the other hand, drugs positively influencing these factors, such as antihypertensives and cholesterol-lowering drugs, could, at least in theory, have a potentially protective effect on the formation and development of the aneurysms. For aortic dissections, systemic hypertension is a central risk factor, and many drugs known to increase systemic blood pressure abruptly are associated with aortic dissections. In addition, abrupt discontinuation of antihypertensive drugs known to cause rebound hypertension, such as the beta blockers, may precipitate aortic dissections. The objective of this chapter is to present a comprehensive review of pharmaceutical products and illicit substances associated with the formation and ruptures of aortic aneurysms. Moreover, drugs implicated in acute aortic dissections are also included. Data from case reports and case series are tabulated for completeness. When relevant, these data are also synthesised in order to provide aggregate information, attempting to identify potential drug-specific risk factors. Results from experimental studies are included to provide an understanding of the underlying mechanisms, and treatment options are discussed when they deviate from conventional therapy.