Diabetes-related factors and abdominal aortic aneurysm events: the Atherosclerotic Risk in Communities Study

Purpose: To test the hypothesis that diabetes-related factors (metabolic syndrome [MetS], glucose, insulin, and leptin) are inversely associated with abdominal aortic aneurysm (AAA) risk. Methods: We followed 13,736 participants, aged 45–64 years, without prior AAA surgery at baseline (1987–1989), for AAA occurrence through 2011. Hazard ratios (HRs) and their 95% confidence intervals (CIs) of AAA were calculated using Cox regression. Results: During 275,054 person-years of follow-up, we identified 518 AAA events. Fasting serum glucose was associated inversely with AAA risk (HR [95% CI] per one unit increment in log ₂ (glucose), 0.54 [0.36–0.80]), but fasting insulin was not associated with AAA. Plasma leptin was also associated inversely with AAA occurrence (HR [95% CI] per one unit increment in log ₂ (leptin), 0.83 [0.71–0.98]). Compared with individuals without MetS, those with MetS had increased risk of AAA (HR [95% CI], 1.24 [1.04–1.48]). Among individuals with or without diabetes, the HRs increased monotonically with a greater number of non-glucose MetS components. Conclusions: Diabetes, fasting glucose, and plasma leptin were inversely associated with risk of AAA. In contrast, the MetS was associated with increased risk of AAA, due to the influence of the non-glucose MetS components.