Diabetes mellitus and aortic aneurysm rupture: a favorable association?

Introduction: Recent reports suggest that diabetic patients are relatively unlikely to have abdominal aortic aneurysms (AAAs). This retrospective study assesses the relationship between diabetes mellitus (DM) and aortic aneurysm rupture.

Methods: Patients with a diagnosis of any aortic aneurysm during a 10-year period were identified from our records. Patients with diagnoses of aortic aneurysm (thoracic, thoracoabdominal, and abdominal, treated and untreated) were included. Patients with nonatheromatous aneurysms (transection, dissection, mycotic, or isolated iliac) were excluded.

Results: In all, 1830 patients with nonruptured aneurysms and 232 ruptured aneurysms were included giving a total of 2062 patients with aortic aneurysms (abdominal, thoracic, and thoracoabdominal). Of these 1830, 225 (12.3%) patients with nonruptured aneurysm were diabetic; however, only 13 (5.6%) of the 232 patients with ruptured aortic aneurysm were diabetic (odds ratio [OR] = 0.42; confidence interval [CI]: 0.23-0.75, P = .004). Considering only those with AAAs, 184 (12.4%) of the 1482 nonruptured AAA were diabetic; however, only 12 (6.4%) of the 188 patients with ruptured AAA were diabetic (OR = 0.48 [CI: 0.26-0.88], P = .02). In this study group, the odds of dying due to aneurysm rupture in the diabetic group are significantly lower compared to the nondiabetic groups (OR = 0.31 [CI: 0.13-0.69], P = .004), despite the finding that diabetic patients had almost the same life expectancy as nondiabetic patients (DM, 73 years [67-80] vs non-DM, 75 years [68-82] P = .23).

Conclusions: Diabetic patients with aortic aneurysms are significantly less likely to present with rupture or to die from aneurysm rupture when compared to nondiabetic patients with aortic aneurysms. We have identified association only, not causality. However, it is plausible that DM, or the treatment of DM, may have a protective effect on aortic aneurysm rupture.