Circulating biomarkers of cardiovascular disease are related to aneurysm volume in abdominal aortic aneurysm

Elke Bouwens, Alexander Vanmaele, Sanne E. Hoeks, Hence J.M. Verhagen, Bram Fioole, Adriaan Moelker, Sander ten Raa, Burhan Hussain, José Oliveira-Pinto, Frederico Bastos Gonçalves, Arne S. Ijpma, Imo E. Hoefer, Felix van Lier, K. Martijn Akkerhuis, Danielle F. Majoor-Krakauer, Eric Boersma, Isabella Kardys

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Background: Surveillance programs in abdominal aortic aneurysms (AAA) are mainly based on imaging and leave room for improvement to timely identify patients at risk for AAA growth. Many biomarkers are dysregulated in patients with AAA, which fuels interest in biomarkers as indicators of disease progression. We examined associations of 92 cardiovascular disease (CVD)-related circulating biomarkers with AAA and sac volume. Methods: In a cross-sectional analysis, we separately investigated (1) 110 watchful waiting (WW) patients (undergoing periodic surveillance imaging without planned intervention) and (2) 203 patients after endovascular aneurysm repair (EVAR). The Cardiovascular Panel III (Olink Proteomics AB, Sweden) was used to measure 92 CVD-related circulating biomarkers. We used cluster analyses to investigate protein-based subphenotypes, and linear regression to examine associations of biomarkers with AAA and sac volume on CT scans. Results: Cluster analyses revealed two biomarker-based subgroups in both WW and EVAR patients, with higher levels of 76 and 74 proteins, respectively, in one subgroup versus the other. In WW patients, uPA showed a borderline significant association with AAA volume. Adjusting for clinical characteristics, there was a difference of −0.092 (−0.148, −0.036) loge mL in AAA volume per SD uPA. In EVAR patients, after multivariable adjustment, four biomarkers remained significantly associated with sac volume. The mean effects on sac volume per SD difference were: LDLR: −0.128 (−0.212, −0.044), TFPI: 0.139 (0.049, 0.229), TIMP4: 0.110 (0.023, 0.197), IGFBP-2: 0.103 (0.012, 0.194). Conclusion: LDLR, TFPI, TIMP4, and IGFBP-2 were independently associated with sac volume after EVAR. Subgroups of patients with high levels of the majority of CVD-related biomarkers emphasize the intertwined relationship between AAA and CVD. Identifier: NCT03703947.

Original languageEnglish
JournalVascular Medicine (United Kingdom)
Publication statusE-pub ahead of print - 3 Jul 2023


  • abdominal aortic aneurysm (AAA)
  • biomarkers
  • cardiovascular diseases
  • endovascular aneurysm repair


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