Nutrition, metabolism, and cardiovascular diseases : NMCD · 2026
Lipids and abdominal aortic aneurysm: from pathophysiology to therapy. A call to action from the Italian Society for the Study of Atherosclerosis and the Italian Society for Angiology and Vascular Medicine.
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Marcucci Rossella, Bucci Marco, Ageno Walter, Arca Marcello, Averna Maurizio, Barbagallo Carlo M, Corsini Alberto, Fortunato Giuliana, Ghirardini Francesca, Pirro Matteo, Suppressa Patrizia, Zamboni Paolo, Zenti Maria Grazia, Martini Romeo, Catapano Alberico L, D'Erasmo Laura, Gentile Luigi
Аннотация
AIMS: To critically evaluate current evidence on the role of lipoproteins and lipid-regulating proteins in the pathophysiology of abdominal aortic aneurysm (AAA), and to explore their diagnostic, prognostic, and therapeutic implications. This joint document by the Italian Society for the Study of Atherosclerosis (SISA) and the Italian Society for Angiology and Vascular Medicine (SIAPAV) integrates mechanistic, genetic, translational, and clinical data to identify emerging therapeutic targets and future research priorities.
DATA SYNTHESIS: A systematic PubMed/MEDLINE search (2013-2025) identified clinical, experimental, genetic, and omic studies investigating lipid metabolism in AAA. Evidence from epidemiological studies, genome-wide association studies, and Mendelian randomization analyses supports a causal role for LDL-cholesterol, triglyceride-rich lipoproteins, and lipoprotein(a) in AAA development and progression. HDL dysfunction, rather than reduced HDL-cholesterol levels alone, has emerged as a key contributor to vascular inflammation and extracellular matrix degradation. Lipid-regulating proteins, particularly PCSK9, ANGPTL3, and apoC-III, have been identified as potential mediators of aneurysm formation through both lipid-dependent and lipid-independent inflammatory pathways. Experimental studies suggest that targeting these pathways may attenuate aneurysm growth and rupture risk. However, despite strong biological plausibility, no dedicated randomised clinical trials have yet demonstrated that lipid-lowering therapies modify AAA progression.
CONCLUSION: Lipid dysregulation is increasingly recognised as a central mechanism in aneurysmal disease. Integrated experimental, genetic, and clinical evidence supports lipid-related pathways as promising diagnostic biomarkers and therapeutic targets. Large-scale longitudinal studies and randomised trials are urgently needed to determine whether lipid-targeted interventions can alter the natural history of AAA and enable precision-based prevention and treatment strategies.
DATA SYNTHESIS: A systematic PubMed/MEDLINE search (2013-2025) identified clinical, experimental, genetic, and omic studies investigating lipid metabolism in AAA. Evidence from epidemiological studies, genome-wide association studies, and Mendelian randomization analyses supports a causal role for LDL-cholesterol, triglyceride-rich lipoproteins, and lipoprotein(a) in AAA development and progression. HDL dysfunction, rather than reduced HDL-cholesterol levels alone, has emerged as a key contributor to vascular inflammation and extracellular matrix degradation. Lipid-regulating proteins, particularly PCSK9, ANGPTL3, and apoC-III, have been identified as potential mediators of aneurysm formation through both lipid-dependent and lipid-independent inflammatory pathways. Experimental studies suggest that targeting these pathways may attenuate aneurysm growth and rupture risk. However, despite strong biological plausibility, no dedicated randomised clinical trials have yet demonstrated that lipid-lowering therapies modify AAA progression.
CONCLUSION: Lipid dysregulation is increasingly recognised as a central mechanism in aneurysmal disease. Integrated experimental, genetic, and clinical evidence supports lipid-related pathways as promising diagnostic biomarkers and therapeutic targets. Large-scale longitudinal studies and randomised trials are urgently needed to determine whether lipid-targeted interventions can alter the natural history of AAA and enable precision-based prevention and treatment strategies.