Letter by Goldstein et al Regarding Article, “Risk Factors for Abdominal Aortic Aneurysms: A 7-Year Prospective Study: The Tromsø Study”
To the Editor:
We read the interesting observational article of Dr Forsdahl and colleagues1 on the risk factors for abdominal aortic aneurysm (AAA). Intriguingly, statin use was associated with a nearly quadruple increase in the risk of AAA. The authors commented that the surprising association of statin therapy and AAA risk was due to residual confounding. However, we suggest that the association might be real.
Although infrequent, statin use has been associated with both tendinitis and tendon rupture.2 It is plausible that statin therapy alters matrix metalloproteinase activity in AAAs3 as well as tendons.4 This might result in a weakening of the connective tissue structures in the aneurysm wall in susceptible individuals, leading to aneurysmal expansion. Therefore, tendinopathy and AAA expansion actually might be a consequence of similar changes in connective tissue metabolism resulting from statin therapy.
In conclusion, we feel that the effect of statin therapy on AAA expansion needs to be investigated prospectively, particularly in the elderly who are at greater risk of aneurysm due to their age.1 Finally, this is relevant since statin therapy is promoted at higher doses in wider segments of the population.5
Forsdahl SH, Singh K, Solberg S, Jacobsen BK. Risk factors for abdominal aortic aneurysms: a 7-year prospective study: the Tromsø Study, 1994–2001. Circulation. 2009; 119: 2202–2208.
Wenger NK, Lewis SJ, Herrington DM, Bittner V, Welty FK, for the Treating to New Targets Steering Committee and Investigators. Outcomes of using high- or low-dose atorvastatin in patients 65 years of age or older with stable coronary heart disease. Ann Intern Med. 2007; 147: 1–9.