Editor's Choice - The Prevalence of Abdominal Aortic Aneurysm in First Degree Relatives: A Systematic Review and Meta-analysis.

Abstract

To summarise current knowledge regarding the prevalence of abdominal aortic aneurysm (AAA) in first degree relatives and provide a summary estimate of the association between AAA heredity and development. Medline, Embase, and Web of Science. PRISMA systematic review guidelines were followed. The literature search covered inception to 13 March 2025. Original English language studies investigating the prevalence of AAA in first degree relatives were included. The Newcastle-Ottawa scale was used for quality assessment. Unadjusted odds ratio (OR) with 95% confidence intervals (CIs) were calculated using random effects meta-analyses. Sensitivity analysis excluding outliers, and a stratified analyses by sex and methodology were performed. Certainty of evidence was assessed with GRADE methodology. The protocol was published in PROSPERO (CRD42025644846). Of 2 276 identified studies, 34 were included in the systematic review and eight in the meta-analysis. Most reported a high prevalence of AAA in first degree relatives (0 - 30%). The meta-analysis estimated that first degree relatives are three times more likely to develop AAA (OR 3.19, 95% CI 1.90 - 5.37, I² = 91.30%; p <.001). Sensitivity analysis using contemporary data estimated an OR of 1.98 (95% CI 1.77 - 2.22) with low heterogeneity. Subgroup analysis estimated an OR of 2.16 (95% CI 1.59 - 2.92) for male and 1.88 (95% CI 1.33 - 2.96) for female first degree relatives. By detection method, ORs were 2.11 (95% CI 1.45 - 3.07) for ultrasound or register and 4.25 (95% CI 1.81 - 9.98) for questionnaire based studies. GRADE indicated very low certainty of evidence for the main results and high for the sensitivity analysis. Despite the lack of scientific evidence in the field, societal guidelines recommend targeted screening of first degree relatives of AAA patients. This meta-analysis shows a more than threefold increased risk of developing AAA in first degree relatives. These results confirm that targeted screening of first degree relatives of patients with AAA should be applied in clinical practice.