Stiffness and aneurysm of the aorta. Relations to vascular aging, hyperglycemia, and inflammation.

A well-functioning arterial system for the transport of oxygen to the cells is essential for human health. The aorta has a key role for the provision of this physiological effect. Disturbances to aortic function can lead to major
symptoms and even death due to ruptured abdominal aortic aneurysm (AAA). Multiple diseases may exacerbate, or alleviate the symptoms of aortic conditions.
This thesis examines the following features potentially affecting aortic function:
Aortic stiffness; the wall of the aorta loses its elasticity and blood travels with excessive speed Horizontal/radial expansion of the abdominal aorta, referred to as AAA Diabetes mellitus (DM), excessive concentration of glucose in the blood stream
The above relationships are complex and the pathways not yet fully clarified by contemporary medical research.
Research has implied a positive link between type 2 DM (DM2) and stiffening but a negative link between type
DM2 and AAA, indicating a need for more studies about details in these correlations. The purpose of this thesis
has been to investigate relationships between:
DM2 and aortic stiffness
Biomarkers and AAA
DM2 and AAA
The research has used data obtained from a number of primary sources:
The cardiovascular arm of the Malmö Diet Cancer Study, and the Malmö Offspring Study
National and regional diabetes registries
The Swedish Vascular Register, Swedvasc
The ultrasound screening program for AAA in Malmö
Statistical calculations have been used with the concept of significance as the pivotal measure of whether an
association could be proven or not. This has yielded a total of five papers, all published in scientific journals with
various co-authors. The main conclusions are:
DM2 is related to aortic stiffness, primarily in older individuals.
None of six evaluated plasma biomarkers predicted aortic diameter 15 – 20 years later
The reported protective effect of DM2 on AAA could not be detected in the early stages of DM2
During follow-up after elective endovascular AAA repair, DM2 was associated with lower need of re-intervention
During follow-up after acute AAA repair, DM2 was associated with lower rates of cardiovascular diseases and
mortality
Plausible explanatory theories for the above mechanisms are discussed, and further research is needed to identify which of these that are most clinically relevant.