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eComment: Approaching the beneficial impact of statins in patients with abdominal aortic aneurysms

Department of Cardiothoracic Surgery, University Hospital of Patras, 22500 Rion Patras, Greece

The use of statins and fate of small abdominal aortic aneurysms

Undoubtedly, your study has a great interest as it reflects the beneficial effect of statins concerning their anti-inflammatory action. It is notable the fact that patients treated with statins had a better survival freedom from aneurysm repair or rupture especially in the long-term (72.3% at five years) [1]. However, the beneficial impact of statins was even more significant in patients with very small abdominal aortic aneurysms (AAA) (baseline aneurysm diameter <40 mm), a fact that possibly confirms the more effective action of statins during the initial stage of aneurysmal degeneration. Probably, statins affect the aneurysm expansion through reduced proteolytic activity and more specifically elastolytic activity within the aortic wall. In fact, Abisi et al. demonstrated that the aortic wall of patients receiving statin treatment had a significantly lower level of active MMP-9 (P<0.001) than in those not on statin treatment, a lower but non-significantly level of active MMP-3 and finally a significantly lower activity of cathepsins H and L [2]. Evans et al. randomized patients undergoing elective open repair of an AAA to a preoperative course of either simvastatin or placebo. It was observed, except for a lower activity of MMP-9, an additional 40% reduction in total MMP-9 concentration in the aortic wall of the simvastatin group [3]. So, your study offers us additional significant clinical evidence concerning the benefit of using statins in patients with abdominal aortic aneurysms, but in our opinion there is a great need for a prospective controlled randomized trial. In addition, trials concerning small aneurysms require long follow-up and accurate aortic imaging in order to assess medication value. In this regard, entry and exit CT with aortic volume and maximum orthogonal aortic diameter would be valuable [4]. Finally, the growth is neither regular nor linear and as a consequence, complex statistical modelling is needed in order to provide unbiased estimates of AAA growth.

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1. Mosorin M, Niemelä E, Heikkinen J, Lahtinen J, Tiozzo V, Satta J, Juvonen T, Biancari F. The use of statins and fate of small abdominal aortic aneurysms. Interact Cardiovasc Thorac Surg 2008;7:578–581.[Abstract/Free Full Text]
2. Abisi S, Burnand KG, Humphries J, Waltham M, Taylor P, Smith A. Effect of statins on proteolytic activity in the wall of abdominal aortic aneurysms. Br J Surg 2008;95:333–337.[CrossRef][Medline]
3. Evans J, Powell JT, Schwalbe E, Loftus IM, Thompson MM. Eur J Vasc Endovasc Surg 2007;34:302–303.[CrossRef][Medline]
4. Golledge J, Powell JT. Medical management of abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 2007;34:267–273.[CrossRef][Medline]

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