Abstract
BACKGROUND: High body mass index (BMI) is a recognized risk factor for cardiovascular diseases, but its impact on aortic aneurysms (AA) remains unclear. This study analyzes the global burden of AA attributed to high BMI in 204 countries between 1990 and 2021. METHODS: Using Global Burden of Disease (GBD) 2021 data, we analyzed AA-related deaths, disability-adjusted life years (DALYs), and age-standardized rates (ASRs), assessing 1990-2021 trends via estimated annual percentage change (EAPC) and projecting 2022-2040 burden with Bayesian Age-Period-Cohort (BAPC) model. The BMI-AA association was investigated through multivariable logistic regression and subgroup analyses in UK Biobank (UKB) participants, supplemented by Mendelian randomization (MR) analyses using Integrative Epidemiology Unit Open GWAS Project (IEU OpenGWAS project) summary statistics. RESULTS: In 2021, AA deaths and DALYs due to high BMI rose to 11 540 and 247 361, respectively, compared to 1990. Despite this increase, ASMR and ASDR declined, with EAPCs of -1.36 and -1.13, respectively. The burden of AA due to high BMI increased in individuals under 45 but decreased significantly in those over 65. Males exhibited higher burden than females, though reductions were greater in males. High sociodemographic index (SDI) regions had elevated burden but declining trends. After adjusting for potential confounding factors, individuals with BMI ≥30 kg/m 2 exhibited a higher risk of AA (OR: 1.28, 95% CI: 1.13-1.46, P = 0.001) compared to those with BMI ≤23 kg/m 2 , and subgroup analyses revealed significant interactions for gender and drinking. MR was adopted to estimate the causal relationships between BMI and AA, and demonstrated that genetically predicted higher BMI was associated with an increased risk of AA. By 2040, the global burden of AA attributable to high BMI is projected to gradually rise. CONCLUSION: Our study highlights that high BMI-related AA remains a major global health issue, with younger men, older women, and lower SDI countries bearing greater burdens. Both UKB data and MR analyses confirm a robust link between elevated BMI and AA risk. Effective BMI management strategies are essential to reduce the future global burden of AA.