The Need for Novel Biomarkers of Abdominal Aortic Aneurysm Disease

Abstract

Abdominal aortic aneurysm (AAA) is a complex disease defined as a pathologic dilatation of the infrarenal aorta that is often accompanied by significant superimposed atherosclerosis, inflammation and thrombosis. AAAs are a significant cause of morbidity and mortality in the United States and worldwide. While some patients may present with lower back pain, abdominal pain or pulsatile abdominal masses, identification of small aneurysms are dependent mostly upon incidental ultrasound evaluation. Furthermore, there remains no good way to predict which small aneurysms will grow to critical size lesions and at what pace. Thus, a significant number of patients are left with long, often stressful, follow-up periods that may be unnecessary. Basic science and clinical studies have added great insight into the pathophysiology of AAAs. However, detailed understanding of the underlying mechanisms of AAA development and expansion are still incomplete. Thus, the major clinical challenges in disease management include the absence of 1) effective non-surgical therapies to prevent progression of early stage disease and 2) adequate means to monitor disease activity and to guide suppressive medical therapies. Serum biomarkers have proved useful in assessing the risk in several disease states including cancer and coronary artery disease. In addition, a number of inflammatory markers have shown correlations to vascular disease status or complications including AAAs, although their utility for individual patients remains unknown. Strategies that combine novel biomarker data (e.g., circulating proteins, genetic polymorphisms, imaging data) with known clinical risk factors should aid in this endeavor.

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