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Review
. 2018 Nov 1;114(13):1702-1713.
doi: 10.1093/cvr/cvy174.

Diabetes and aortic aneurysm: current state of the art

Juliette Raffort  1   2   3   4 , Fabien Lareyre  1   4   5 , Marc Clément  1 , Réda Hassen-Khodja  4   5 , Giulia Chinetti  3   4 , Ziad Mallat  1   2
Affiliations
Review

Diabetes and aortic aneurysm: current state of the art

Juliette Raffort et al. Cardiovasc Res. .

Abstract

Aortic aneurysm is a life-threatening disease due to the risk of aortic rupture. The only curative treatment available relies on surgical approaches; drug-based therapies are lacking, highlighting an unmet need for clinical practice. Abdominal aortic aneurysm (AAA) is frequently associated with atherosclerosis and cardiovascular risk factors including male sex, age, smoking, hypertension, and dyslipidaemia. Thoracic aortic aneurysm (TAA) is more often linked to genetic disorders of the extracellular matrix and the contractile apparatus but also share similar cardiovascular risk factors. Intriguingly, a large body of evidence points to an inverse association between diabetes and both AAA and TAA. A better understanding of the mechanisms underlying the negative association between diabetes and aortic aneurysm could help the development of innovative diagnostic and therapeutic approaches to tackle the disease. Here, we summarize current knowledge on the relationship between glycaemic parameters, diabetes, and the development of aortic aneurysm. Cellular and molecular pathways that underlie the protective effect of diabetes itself and its treatment are reviewed and discussed, along with their potential implications for clinical translation.

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Figures

Figure 1
Figure 1
Hypothesized protective effects of diabetes mellitus in AAA and TAA. The main mechanisms that underlie the protective effect of diabetes in the pathogenesis of aortic aneurysm are mediated through effects on aortic mural neoangiogenesis, intraluminal thrombus formation, inflammation, glycation, extracellular matrix remodelling, and vascular smooth muscle homeostasis. Even though AAA and TAA share common pathophysiological mechanisms, they are characterized by distinct features. The main pathways underlying the protective effect of diabetes mellitus may differ between AAA and TAA.
Figure 2
Figure 2
Hypothesized protective effects of antidiabetic treatments in AAA. Antidiabetic treatments may contribute to the negative association observed between diabetes and AAA through protective effects on inflammation, neoangiogenesis, extracellular matrix remodelling, and oxidative stress.
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