Which risk factor is associated with the highest rate of aneurysm expansion and rupture in the context of an abdominal aortic aneurysm?

Active smoking is associated with the highest rate of aneurysm expansion and rupture in the context of an abdominal aortic aneurysm due to several physiological effects that smoking has on vascular health. Smoking has been shown to influence various mechanisms, including increased inflammation, oxidative stress, and alterations in the structure and function of vascular smooth muscle. These changes can lead to the weakening of the aortic wall and promote the progression of aneurysm formation.

Moreover, smoking significantly increases the risk of cardiovascular disease and is a well-established risk factor for aortic aneurysms. It not only contributes to the initial development of abdominal aortic aneurysms but also accelerates their growth and increases the likelihood of rupture. Compared to other factors such as diabetes mellitus, hypertension, and hypercholesterolemia, the impact of active smoking on aneurysm dynamics is markedly substantial and has been consistently recognized in clinical studies. Therefore, the strong association between active smoking and adverse outcomes in patients with abdominal aortic aneurysms highlights its role as a critical risk factor.