Associations of antidiabetic medications with abdominal aortic aneurysm growth and clinical outcomes: A systematic review and meta-analysis
Abstract
Objective: This review aimed to evaluate the association between different antidiabetic agents, abdominal aortic aneurysm (AAA) growth, and related events.
Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PROSPERO CRD420251115799), MEDLINE, Embase, and CENTRAL were searched through January 2026. Eligible studies evaluated antidiabetic drugs compared with not using the medication of interest and reported AAA growth and/or AAA-related events. The risk of bias was assessed using Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) and RoB 2 for nonrandomized and randomized trials, respectively. Pooled estimates (mean difference [MD], odds ratio [OR], and hazard ratio [HR]) were calculated using inverse variance random-effects models.
Results: Thirteen studies (15 distinct cohorts; 150,630 participants) were included. Metformin was associated with slower AAA growth (MD, -0.65 mm/year; 95% confidence interval [CI], -0.97 to -0.33) and lower AAA-related events (OR, 0.63; 95% CI, 0.41-0.95). Moreover, sulfonylureas reduced AAA growth (MD, -0.35 mm/year; 95% CI, -0.52 to -0.18) and AAA-related events (OR, 0.63; 95% CI, 0.52-0.77). Findings for dipeptidyl peptidase-4 inhibitors were not statistically significant in relation to AAA growth (MD, -0.32 mm/year; 95% CI, -0.71 to 0.08). Metformin was not significantly associated with postoperative mortality (HR, 0.86; 95% CI, 0.65-1.13). Most studies were observational, with a…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 150,630 participants or records.
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