Aneurysmal degeneration of the abdominal aorta (referred to as AAA) is a common, and potentially lethal, progressive age-related disease. Formation and progression of an AAA is multifactorial and associated with advanced age, history of cigarette smoking, male gender, and family history. Increased aortic aneurysm size greater than 5.5 cm is associated with increased risk of rupture, which can be rapidly fatal. Despite advances in surveillance imaging and early identification of small aneurysms, there has not been a significant improvement in medical therapy to slow AAA progression. Currently, therapy remains surgical repair with either open or endovascular treatment of rapidly growing aneurysms or those with a maximal aortic diameter greater than 5.5 cm. Recently, there is increased evidence from several studies suggesting that statins may influence aneurysm rupture risk and 30-day mortality following repair, presumably via pleiotropic effects. There remains, to date, no widely accepted preferential medical therapy to prevent growth of AAA. Interestingly, despite the focus on antihypertensive regimens, metformin has been identified in meta-analyses as a promising therapeutic strategy to reduce aneurysm growth rate with an ongoing NIH clinical trial.