Statins in abdominal aortic aneurysm: a risk–benefit analysis

PURPOSE OF REVIEW: To evaluate emerging evidence supporting statins as a potential disease-modifying treatment for abdominal aortic aneurysm (AAA), a condition without approved pharmacological therapy. RECENT FINDINGS: Recent nationwide registry analyses and prospective screening cohorts demonstrate consistent dose-dependent associations between statin exposure and reduced AAA growth, rupture, and surgical repair. In Danish screening trial cohorts, maximal statin exposure was associated with an approximately 0.88 mm/year reduction in aneurysm expansion, nearly halving observed growth rates. Mendelian randomization studies support a causal role of lipid pathways in AAA development and implicate HMG-CoA reductase activity in aneurysm development risk. The contribution of statins' pleiotropic effects may increase as AAA progresses, although direct clinical evidence remains limited. Contemporary randomized trial meta-analyses confirm a favourable safety profile, with only small excess risks of muscle symptoms and dysglycaemia. SUMMARY: Convergent evidence from meta-analyses, drug-wide association study, prospective dose-response cohorts, and Mendelian randomization identifies high-intensity statin therapy as a leading pharmacological candidate for slowing AAA progression. Important uncertainties remain, including the absence of randomized trials and limited evidence in women. Nevertheless, given the favourable safety profile and the near-universal cardiovascular indication in this population, current evidence supports consideration of high-intensity statin therapy in patients with AAA.