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Current <jats:styled-content style=\"fixed-case\">AAA<\/jats:styled-content> treatment is by open surgical or endovascular aneurysm repair. Rodent model and human epidemiology, and genetic and observational studies over the last few decades have highlighted the potential of a number of drug therapies, including medications that lower blood pressure, correct dyslipidaemia, or inhibit thrombosis, inflammation or matrix remodelling, as approaches to managing small <jats:styled-content style=\"fixed-case\">AAA<\/jats:styled-content>. This review summarizes prior <jats:styled-content style=\"fixed-case\">AAA<\/jats:styled-content> pathogenesis data from animal and human studies aimed at identifying targets for the development of drug therapies. The review also systematically assesses past randomized placebo\u2010controlled drug trials in patients with small <jats:styled-content style=\"fixed-case\">AAA<\/jats:styled-content>s. Eleven previously published randomized\u2010controlled clinical trials testing different drug therapies aimed at slowing <jats:styled-content style=\"fixed-case\">AAA<\/jats:styled-content> progression were identified. Five of the trials tested antibiotics and three trials assessed medications that lower blood pressure. Meta\u2010analyses of these trials suggested that neither of these approaches limit <jats:styled-content style=\"fixed-case\">AAA<\/jats:styled-content> growth. Allocation to blood pressure\u2010lowering medication was associated with a small reduction in <jats:styled-content style=\"fixed-case\">AAA<\/jats:styled-content> rupture or repair, compared to placebo (relative risk 0.94, 95% confidence intervals 0.89, 1.00, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.047). Three further trials assessed the effect of a mast cell inhibitor, fibrate or platelet aggregation\u00a0inhibition and reported no effect on <jats:styled-content style=\"fixed-case\">AAA<\/jats:styled-content> growth or clinical events. Past trials were noted to have a number of design issues, particularly small sample sizes and limited follow\u2010up. Much larger trials are needed to properly test potential therapeutic approaches if a convincingly effective medical therapy for <jats:styled-content style=\"fixed-case\">AAA<\/jats:styled-content> is to be identified.<\/jats:p>","DOI":"10.1111\/joim.12958","type":"journal-article","created":{"date-parts":[[2019,7,6]],"date-time":"2019-07-06T10:57:32Z","timestamp":1562410652000},"page":"6-22","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":158,"title":["Lack of an effective drug therapy for abdominal aortic aneurysm"],"prefix":"10.1111","volume":"288","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5779-8848","authenticated-orcid":false,"given":"J.","family":"Golledge","sequence":"first","affiliation":[{"name":"From the Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Qld Australia"},{"name":"The Department of Vascular and Endovascular Surgery The Townsville Hospital Townsville Qld Australia"},{"name":"Centre for Molecular Therapeutics The Australian Institute of Tropical Health and Medicine James Cook University Townsville Qld Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. V.","family":"Moxon","sequence":"additional","affiliation":[{"name":"From the Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Qld Australia"},{"name":"Centre for Molecular Therapeutics The Australian Institute of Tropical Health and Medicine James Cook University Townsville Qld Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. P.","family":"Singh","sequence":"additional","affiliation":[{"name":"From the Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Qld Australia"},{"name":"The Department of Vascular and Endovascular Surgery The Townsville Hospital Townsville Qld Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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