Diabetes, its duration, and the long-term risk of abdominal aortic aneurysm: The Atherosclerosis Risk in Communities (ARIC) Study

Xuejuan Ning, Ning Ding, Shoshana H. Ballew, Caitlin W. Hicks, Josef Coresh, Elizabeth Selvin, James Pankow, Weihong Tang, Kunihiro Matsushita

Research output: Contribution to journalArticlepeer-review

Abstract

Background and aims: We aimed at comprehensively evaluate the independent association of diabetes and its duration with incident abdominal aortic aneurysm (AAA) and aortic diameter. Methods and results: We prospectively studied incident AAA according to baseline glycemic status (diabetes, prediabetes, normal glycemia) in 13,116 ARIC participants (1990–1992) and the time-varying exposure of duration post incident diabetes in 11,675 participants (1987–1989) using Cox models. Additionally, we cross-sectionally explored ultrasound-based abdominal aortic diameter by glycemic status and cumulative duration of diabetes in 4710 participants (2011–2013) using linear regression models. Over ~20 years of follow-up, diabetes (vs. normal glycemia) at baseline was independently associated with lower AAA risk (489 cases) (hazard ratio: 0.71 [95%CI 0.51–0.99]), especially after 10 years (hazard ratio: 0.58 [0.38–0.87]). Prediabetes did not demonstrate an independent association. The inverse association was more evident with longer duration of diabetes (p for trend = 0.045), with 30–50% lower risk in eight years after diabetes diagnosis. The cross-sectional analysis demonstrated smaller aortic diameters with longer duration of diabetes (e.g., −0.76 mm [−1.24, −0.28] in diabetes with 8–12 years) compared to non-diabetes, whereas prediabetes consistently showed nominally greater diameter. Conclusions: Diabetes, especially with longer duration, but not prediabetes, was independently associated with lower risk of AAA and smaller aortic diameter. Our findings suggest that long lasting clinical hyperglycemia plays an important role in the reduced AAA risk, and the reduced aortic diameter may be a structural mechanism behind this paradoxical association.

Original languageEnglish (US)
Pages (from-to)137-143
Number of pages7
JournalAtherosclerosis
Volume313
DOIs
StatePublished - Nov 2020

Bibliographical note

Funding Information:
The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute , National Institutes of Health , Department of Health and Human Services , under Contract nos. ( HHSN268201700001I , HHSN268201700002I , HHSN268201700003I , HHSN268201700005I , HHSN268201700004I ). The present study was supported by NHLBI grant R01HL103695 .

Keywords

  • Abdominal aortic aneurysm
  • Aortic diameter
  • Diabetes
  • Prediabetes

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

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