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Previous studies imply a profound residual mortality risk following successful abdominal aorta aneurysm (AAA) repair. This excess mortality is generally attributed to increased cardiovascular risk. The aim of this study was (I) to quantify the excess residual mortality for AAA patients, (II) to evaluate the cross-sectional level of cardiovascular risk management, and (III) to estimate the potential of optimized cardiovascular risk-management to reduce the excess mortality in these patients.Excess mortality was estimated through a systematic review and meta-analysis, and through data from the Swedish National Health Registry. Cardiovascular risk-profiles were individually assessed during eligibility screening of AAA patients for two multi-center pharmaceutical AAA-stabilization trials. The potential of full implementation of cardiovascular risk management was estimated through the validated SMART risk-scores algorithm.The meta-analysis showed a similarly impaired survival for patients who received early repair (small AAA) or regular repair (≥55mm), and a further impaired survival for patients under surveillance for a small AAA. Excess mortality was further quantified using Swedish population data. The data revealed a, respectively more than quadrupled and doubled 5-years mortality rate for women and men who had their AAA repaired. Evaluation of the level of risk-management of 358 patients under surveillance in 16 Dutch hospitals showed that the majority of AAA patients did not meet therapeutic targets set for risk-management in high risk populations, and indicated a more pronounced prevention-gap in women. Application of the SMART risk-score algorithm predicted that optimal implementation of risk-management guidelines would reduce the 10-years risk of major adverse cardiovascular events from 43% to 14%.Independent of the rupture risk, AAA associates with a worryingly compromised life-expectancy with a particular poor prognosis for women. Optimal implementation of cardiovascular risk prevention guidelines is predicted to profoundly reduce cardiovascular risk. However, the prediction tool estimate changes in life expectancy.