An abdominal aortic aneurysm (AAA) is a cardiovascular disease where the aorta in the abdomen is larger than normal. A recent meta-analysis, published in the scientific journal British Journal of Surgery, looks at the association between alcohol consumption and this disease. The researchers found a lower risk when consuming 10-15g alcohol per day. More research is needed to further investigate the association.

What is already known? More than three glasses of alcohol a day seem to be a risk factor for abdominal aortic aneurysm (AAA)2, but studies are limited and inconclusive. The association between alcohol and cardiovascular diseases in general is well-known: a J-shaped curve, where moderate drinkers have a lower risk compared to non-drinkers.

What does this study add? This is a first meta-analysis of observational studies that looks at the association between alcohol and AAA using a dose-response analysis. A causal relationship cannot be identified with this analysis. The underlying mechanism is also not investigated here.

No association
The meta-analysis1 takes into account 11 western studies with in total almost half a million participants who have been followed for 5 to 34 years. The alcohol consumption varies between 0 and 80 g per day, with limited data available for the highest intakes. Overall, the results do not show a clear association between alcohol consumption and AAA.

Dose-response
Previous studies show that the association between alcohol and cardiovascular diseases in general describes a J-shaped curve. The current meta-analysis indicates that the risk of AAA is decreased at a consumption of 10-15g alcohol per day. With higher intakes the risk increases again. In addition, men seem to have a higher risk than women1.

Abdominal aortic aneurysm
An abdominal aortic aneurysm (AAA) is an enlarged area in the lower aorta3. The prevalence of AAA ranges from 2-8% in adults above 65 years. Most AAA’s are asymptomatic until they reach a diameter of 55mm. In that case, there is a substantially increased risk of rupture of the aorta, which can be life-threatening in many cases1. Known risk factors for AAA development are an increasing age, male sex, and smoking1,3.

Mechanism
Although the current meta-analysis did not investigate the underlying mechanism, there are some hypotheses. Enlargement of the aorta would mainly be caused by chronic inflammation of the arterial wall, making it stiff and weaker. Many people with an AAA also suffer from artheriosclerosis2. The protective effects of moderate alcohol consumption, such as better cholesterol values and decreased plaques formation, might also lower the risk of an aneurysm1.

Strengths of this study
• Dose-response association investigated
• Western studies (Europe and USA) included in the analysis.
• Separate analyses for men and women.

Limitations of this study
• The included studies did not all adjust for the same factors.
• The included studies differ in study design and method.
• The studies did not take changes in drinking patterns into account. Binge drinkers or sick-quitters could possibly influence the association, compared to moderate drinkers.

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