Objectives: Data regarding the relationship between diabetes and abdominal aortic aneurysm (AAA) are inconsistent across studies: some studies showed an inverse relationship while others did not show an association. We conducted a meta-analysis to examine the association between diabetes and AAA based on published data from case-control and cohort studies.
Methods: We searched literature in English from online databases including MEDLINE (1966-), EMBASE and Web of Science as of July 2017, plus a manual examination of references in selected articles. The eligibility criteria included (1) a case-control or cohort study conducted in adults; (2) diabetes is the exposure variable and AAA risk is the outcome variable; and (3) association estimates (hazard ratios, odds ratios or relative risks) and measurement of variance (P value, confidence interval, or standard error) were available. The literature review and data abstraction were conducted in duplicate by independent investigators. A DerSimonian and Laird random effects model was used to pool association estimates and their 95% confidence intervals from studies using STATA 13. The Cochran’s Q test was used to assess the presence of heterogeneity and the I-square index to quantify the extent of heterogeneity.
Results: We included in the meta-analyses a total of 10 cohorts with 10,771 AAAs in 2,625,318 participants and 4 case-control studies with 1,065 AAAs and 11,009 controls that met the pre-determined eligibility criteria. The samples were predominantly white (88%). Study-specific relative risk and pooled relative risk as well as heterogeneity test results were shown in Figure. Diabetes was inversely associated with AAA risk (pooled relative risk: 0.55; 95%CI: 0.49 - 0.61, Figure). Results were overall consistent by sex, study design and setting (hospital- vs community-based).
Conclusions: The findings suggest that diabetes is strongly and inversely associated with the risk of AAA. Future studies are warranted to investigate the potential mechanisms.