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. 2023 Oct;28(5):433-442.
doi: 10.1177/1358863X231181159. Epub 2023 Jul 3.

Circulating biomarkers of cardiovascular disease are related to aneurysm volume in abdominal aortic aneurysm

Elke Bouwens  1   2   3 , Alexander Vanmaele  1   2 , Sanne E Hoeks  3 , Hence Jm Verhagen  2 , Bram Fioole  4 , Adriaan Moelker  5 , Sander Ten Raa  2 , Burhan Hussain  5   6 , José Oliveira-Pinto  2   7   8 , Frederico Bastos Gonçalves  2   9   10 , Arne S Ijpma  11 , Imo E Hoefer  12 , Felix van Lier  3 , K Martijn Akkerhuis  1 , Danielle F Majoor-Krakauer  11 , Eric Boersma  1 , Isabella Kardys  1
Affiliations

Circulating biomarkers of cardiovascular disease are related to aneurysm volume in abdominal aortic aneurysm

Elke Bouwens et al. Vasc Med. 2023 Oct.

Abstract

Background: Surveillance programs in abdominal aortic aneurysms (AAA) are mainly based on imaging and leave room for improvement to timely identify patients at risk for AAA growth. Many biomarkers are dysregulated in patients with AAA, which fuels interest in biomarkers as indicators of disease progression. We examined associations of 92 cardiovascular disease (CVD)-related circulating biomarkers with AAA and sac volume.

Methods: In a cross-sectional analysis, we separately investigated (1) 110 watchful waiting (WW) patients (undergoing periodic surveillance imaging without planned intervention) and (2) 203 patients after endovascular aneurysm repair (EVAR). The Cardiovascular Panel III (Olink Proteomics AB, Sweden) was used to measure 92 CVD-related circulating biomarkers. We used cluster analyses to investigate protein-based subphenotypes, and linear regression to examine associations of biomarkers with AAA and sac volume on CT scans.

Results: Cluster analyses revealed two biomarker-based subgroups in both WW and EVAR patients, with higher levels of 76 and 74 proteins, respectively, in one subgroup versus the other. In WW patients, uPA showed a borderline significant association with AAA volume. Adjusting for clinical characteristics, there was a difference of -0.092 (-0.148, -0.036) loge mL in AAA volume per SD uPA. In EVAR patients, after multivariable adjustment, four biomarkers remained significantly associated with sac volume. The mean effects on sac volume per SD difference were: LDLR: -0.128 (-0.212, -0.044), TFPI: 0.139 (0.049, 0.229), TIMP4: 0.110 (0.023, 0.197), IGFBP-2: 0.103 (0.012, 0.194).

Conclusion: LDLR, TFPI, TIMP4, and IGFBP-2 were independently associated with sac volume after EVAR. Subgroups of patients with high levels of the majority of CVD-related biomarkers emphasize the intertwined relationship between AAA and CVD.ClinicalTrials.gov Identifier: NCT03703947.

Keywords: abdominal aortic aneurysm (AAA); biomarkers; cardiovascular diseases; endovascular aneurysm repair (EVAR).

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Conflict of interest statement

Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Association of biomarkers with aneurysm volume in watchful waiting patients. This figure represents the results of univariable linear regressions where we examined associations of individual biomarkers with AAA volume for the watchful waiting patients. Results are presented as the mean effect (β) with 95% CI of a 1 SD difference of the biomarker on AAA volume (expressed as natural log mL). AAA, abdominal aortic aneurysm.
Figure 2.
Figure 2.
Association of biomarkers with aneurysm sac volume in patients after EVAR. This figure represents the results of univariable linear regression where we examined associations of individual biomarkers with sac volume for patients after EVAR. Results are presented as the mean effect (β) with 95% CI of a 1 SD difference of the biomarker on sac volume (expressed as natural log mL). EVAR, endovascular aneurysm repair.
See this image and copyright information in PMC

References

    1. Sakalihasan N, Limet R, Defawe OD. Abdominal aortic aneurysm. Lancet 2005; 365: 1577–1589. - PubMed
    1. Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2019; 57: 8–93. - PubMed
    1. Collaborators R, Bown MJ, Sweeting MJ, et al. Surveillance intervals for small abdominal aortic aneurysms: A meta-analysis. JAMA 2013; 309: 806–813. - PubMed
    1. Bastos Gonçalves F, Baderkhan H, Verhagen HJ, et al. Early sac shrinkage predicts a low risk of late complications after endovascular aortic aneurysm repair. Br J Surg 2014; 101: 802–810. - PMC - PubMed
    1. O’Donnell TFX, Deery SE, Boitano LT, et al. Aneurysm sac failure to regress after endovascular aneurysm repair is associated with lower long-term survival. J Vasc Surg 2019; 69: 414–422. - PubMed

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