Statins Reduce Abdominal Aortic Aneurysm Growth, Rupture, and Perioperative Mortality: A Systematic Review and Meta‐Analysis

<jats:sec xml:lang="en"> <jats:title>Background</jats:title> <jats:p xml:lang="en"> There are no recognized pharmacological treatments for abdominal aortic aneurysms ( <jats:styled-content style="fixed-case">AAA</jats:styled-content> ), although statins are suggested to be beneficial. We sought to summarize the literature regarding the effects of statins on human <jats:styled-content style="fixed-case">AAA</jats:styled-content> growth, rupture, and 30‐day mortality. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Methods and Results</jats:title> <jats:p xml:lang="en"> We conducted a systematic review and meta‐analysis of randomized and observational studies using the Cochrane <jats:styled-content style="fixed-case">CENTRAL</jats:styled-content> database, <jats:styled-content style="fixed-case">MEDLINE</jats:styled-content> , and <jats:styled-content style="fixed-case">EMBASE</jats:styled-content> up to June 15, 2018. Review, abstraction, and quality assessment were conducted by 2 independent reviewers, and a third author resolved discrepancies. Pooled mean differences and odds ratios with 95% confidence intervals were calculated using random effects models. Heterogeneity was quantified using the I <jats:sup>2</jats:sup> statistic, and publication bias was assessed using funnel plots. Our search yielded 911 articles. One case‐control and 21 cohort studies involving 80 428 patients were included. The risk of bias was low to moderate. Statin use was associated with a mean <jats:styled-content style="fixed-case">AAA</jats:styled-content> growth rate reduction of 0.82 mm/y (95% confidence interval 0.33, 1.32, <jats:italic>P</jats:italic> =0.001, I <jats:sup>2</jats:sup> =86%). Statins were also associated with a lower rupture risk (odds ratio 0.63, 95% confidence interval 0.51, 0.78, <jats:italic>P</jats:italic> <0.0001, I <jats:sup>2</jats:sup> =27%), and preoperative statin use was associated with a lower 30‐day mortality following elective <jats:styled-content style="fixed-case">AAA</jats:styled-content> repair (odds ratio 0.55, 95% confidence interval 0.36, 0.83, <jats:italic>P</jats:italic> =0.005, I <jats:sup>2</jats:sup> =57%). </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Conclusions</jats:title> <jats:p xml:lang="en"> Statin therapy may be associated with reduction in <jats:styled-content style="fixed-case">AAA</jats:styled-content> progression, rupture, and lower rates of perioperative mortality following elective <jats:styled-content style="fixed-case">AAA</jats:styled-content> repair. These data argue for widespread statin use in <jats:styled-content style="fixed-case">AAA</jats:styled-content> patients. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Clinical Trial Registration</jats:title> <jats:p xml:lang="en"> <jats:styled-content style="fixed-case">URL</jats:styled-content> : <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.crd.york.ac.uk">www.crd.york.ac.uk</jats:ext-link> . Unique identifier: <jats:styled-content style="fixed-case">CRD</jats:styled-content> 42017056480. </jats:p> </jats:sec>