The Effect of Medical Therapies for Subthreshold Abdominal Aortic Aneurysm Growth and Mortality: A Network Meta-Analysis of Randomized Controlled Trials
Abstract
Objectives: Abdominal aortic aneurysm (AAA) is often fatal when ruptured, and current guidelines suggest surgical management at suprathreshold sizes (50 mm for women or 55 mm for men) or with rapid expansion (>5 mm/year). Many medical therapies have been assessed for reducing subthreshold AAA expansion, though the evidence remains inconclusive. This network meta-analysis (NMA) compares AAA growth and mortality amongst medical treatments for AAAs.
Methods: MEDLINE (via PubMed), Scopus, Web of Science, EBSCO, and Cochrane Library databases were searched for relevant randomized controlled trials (RCTs) from database inception to 2024. Outcomes assessed included AAA growth rate, rate of referral for aneurysm surgery, overall mortality, and discontinuation from adverse effects. Data were analysed using R software, and P-score were used to rank different treatments. The GRADE framework was performed to assess the quality of evidence.
Results: Thirteen RCTs comprising 3084 patients were included in this NMA. Abdominal aortic aneurysm diameters ranged from 3.1 to 4.6 cm in the intervention group and 3.5-4.5 cm in the placebo group. Study-level mean annual growth rate ranged from 1.2 to 2.8 mm/year in the intervention group compared with placebo (1.2-2.6 mm/year). There were no significant differences in AAA growth among the compared groups (P-score probability in brackets): propranolol (0.73), telmisartan (0.66), antibiotics (0.53), placebo (0.53), ACE inhibitors (0.52), ticagrelor…
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: 3,084 participants or records.
Read the paper
Related studies
- Metformin as an adjuvant in breast cancer treatment
- Metformin Lysosomal Targeting: A Novel Aspect to Be Investigated for Metformin Repurposing in Neurodegenerative Diseases?
- Aberrant HSF1 signaling activation underlies metformin amelioration of myocardial infarction in mice
- Metformin induces ZFP36 by mTORC1 inhibition in cervical cancer-derived cell lines
- Protein Interaction Network for Identifying Vascular Response of Metformin (Oral Antidiabetic)
- Preventing Long COVID With Metformin
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.