Effect of Statin Drugs on Thoracic Aortic Aneurysms

      Pharmacologic interventions for thoracic aneurysms remain poorly characterized. The results of a pilot study by our group suggested improved outcomes among patients with thoracic aortic aneurysm who were taking statins. In the present study, we undertook a comprehensive analysis of a larger cohort of patients from the Database of the Aortic Institute at Yale-New Haven Hospital. A total of 1,560 patients met the inclusion criteria. The adverse events (i.e., death, dissection, or rupture) and surgery rates for patients with (n = 369, 24%) and without (n = 1,191, 76%) statin therapy were compared. We evaluated 3 anatomic components of the aorta: root, ascending and arch, and descending and thoracoabdominal aortic aneurysms. A smaller proportion of the statin group had adverse events: overall, 7% versus 15%; ascending and arch, 6% versus 15%; and descending and thoracoabdominal aortic aneurysms, 8% versus 20%. Also, a smaller proportion of statin patients required surgery: overall, 48% versus 60%; ascending and arch, 51% versus 62%; and descending and thoracoabdominal aortic aneurysms, 36% versus 59% (p <0.001 to 0.01). The protective effect of statins was seen in all segments, except the aortic root. Log-rank evaluation of the interval to an adverse event or surgery was longer among statin-treated patients (p <0.001). Logistic regression analysis found statin use, angiotensin receptor blocker use, and chronic obstructive pulmonary disease were associated with decreased adverse events, and statin use, angiotensin receptor blocker use, β-blocker therapy, and age were associated with a decreased odds of requiring surgery. Multiple logistic regression analysis found only statins were associated with a decreased odds of an adverse event and that statins, coronary artery disease, and chronic obstructive pulmonary disease were associated with a decreased odds of undergoing surgery. In conclusion, these findings provide a medicinal option for the arsenal of treatment options for patients with aneurysms of the thoracic aorta.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Danyi P.
        • Elefteriades J.A.
        • Jovin I.S.
        Medical therapy of thoracic aortic aneurysms: are we there yet?.
        Circulation. 2011; 124: 1469-1476
        • Schouten O.
        • Kok N.F.
        • Boersma E.
        • Bax J.J.
        • Feringa H.H.
        • Vidakovic R.
        • Statius van Eps R.G.
        • van Sambeek M.R.
        • Poldermans D.
        Effects of statins on renal function after aortic cross clamping during major vascular surgery.
        Am J Cardiol. 2006; 97: 1383-1385
        • Schlosser F.J.
        • Tangelder M.J.
        • Verhagen H.J.
        • van der Heijden G.J.
        • Muhs B.E.
        • van der Graaf Y.
        • Moll F.L.
        Growth predictors and prognosis of small abdominal aortic aneurysms.
        J Vasc Surg. 2008; 47: 1127-1133
        • Karrowni W.
        • Dughman S.
        • Hajj G.P.
        • Miller Jr., F.J.
        Statin therapy reduces growth of abdominal aortic aneurysms.
        J Invest Med. 2011; 59: 1239-1243
        • Schmoker J.D.
        • McPartland K.J.
        • Fellinger E.K.
        • Boyum J.
        • Trombley L.
        • Ittleman F.P.
        • Terrien III, C.
        • Stanley A.
        • Howard A.
        Matrix metalloproteinase and tissue inhibitor expression in atherosclerotic and nonatherosclerotic thoracic aortic aneurysms.
        J Thorac Cardiovasc Surg. 2007; 133: 155-161
        • Luan Z.
        • Chase A.J.
        • Newby A.C.
        Statins inhibit secretion of metalloproteinases-1, -2, -3, and -9 from vascular smooth muscle cells and macrophages.
        Arterioscler Thromb Vasc Biol. 2003; 23: 769-775
        • Hung A.
        • Zafar M.
        • Mukherjee S.
        • Tranquilli M.
        • Scoutt L.M.
        • Elefteriades J.A.
        Carotid intima-media thickness provides evidence that ascending aortic aneurysm protects against systemic atherosclerosis.
        Cardiology. 2012; 123: 71-77
        • Cheung C.
        • Bernardo A.S.
        • Trotter M.W.
        • Pedersen R.A.
        • Sinha S.
        Generation of human vascular smooth muscle subtypes provides insight into embryological origin-dependent disease susceptibility.
        Nat Biotechnol. 2012; 30: 165-173
        • El-Hamamsy I.
        • Yacoub M.H.
        Cellular and molecular mechanisms of thoracic aortic aneurysms.
        Nat Rev Cardiol. 2009; 6: 771-786
        • Coady M.A.
        • Rizzo J.A.
        • Hammond G.L.
        • Mandapati D.
        • Darr U.
        • Kopf G.S.
        • Elefteriades J.A.
        What is the appropriate size criterion for resection of thoracic aortic aneurysms?.
        J Thorac Cardiovasc Surg. 1997; 113 (discussion 489–491): 476-491
        • Davies R.R.
        • Goldstein L.J.
        • Coady M.A.
        • Tittle S.L.
        • Rizzo J.A.
        • Kopf G.S.
        • Elefteriades J.A.
        Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size.
        Ann Thorac Surg. 2002; 73 (discussion 27, 18): 17-27
        • Elefteriades J.A.
        Natural history of thoracic aortic aneurysms: indications for surgery, and surgical versus nonsurgical risks.
        Ann Thorac Surg. 2002; 74 (discussion S1892–S1878): S1877-S1880
        • Danyi P.
        • Elefteriades J.A.
        • Jovin I.S.
        Medical therapy of thoracic aortic aneurysms.
        Trends Cardiovasc Med. 2012; 22: 180-184
        • Meijer C.A.
        • Kokje V.B.
        • van Tongeren R.B.
        • Hamming J.F.
        • van Bockel J.H.
        • Moller G.M.
        • Lindeman J.H.
        An association between chronic obstructive pulmonary disease and abdominal aortic aneurysm beyond smoking: results from a case-control study.
        Eur J Vasc Endovasc Surg. 2012; 44: 153-157
        • Isselbacher E.M.
        Thoracic and abdominal aortic aneurysms.
        Circulation. 2005; 111: 816-828
        • Elefteriades J.A.
        Thoracic aortic aneurysm: reading the enemy's playbook.
        Yale J Biol Med. 2008; 81: 175-186
        • Habashi J.P.
        • Judge D.P.
        • Holm T.M.
        • Cohn R.D.
        • Loeys B.L.
        • Cooper T.K.
        • Myers L.
        • Klein E.C.
        • Liu G.
        • Calvi C.
        • Podowski M.
        • Neptune E.R.
        • Halushka M.K.
        • Bedja D.
        • Gabrielson K.
        • Rifkin D.B.
        • Carta L.
        • Ramirez F.
        • Huso D.L.
        • Dietz H.C.
        Losartan, an AT1 antagonist, prevents aortic aneurysm in a mouse model of Marfan syndrome.
        Science. 2006; 312: 117-121
        • Evangelista A.
        Diseases of the aorta: aneurysm of the ascending aorta.
        Heart. 2010; 96: 979-985
        • Ruddy J.M.
        • Jones J.A.
        • Spinale F.G.
        • Ikonomidis J.S.
        Regional heterogeneity within the aorta: relevance to aneurysm disease.
        J Thorac Cardiovasc Surg. 2008; 136: 1123-1130
        • Brooke B.S.
        • Habashi J.P.
        • Judge D.P.
        • Patel N.
        • Loeys B.
        • Dietz III, H.C.
        Angiotensin II blockade and aortic-root dilation in Marfan's syndrome.
        N Engl J Med. 2008; 358: 2787-2795