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. 2019 Sep 1;76(9):1088-1098.
doi: 10.1001/jamaneurol.2019.1812.

Association Between Idiopathic Intracranial Hypertension and Risk of Cardiovascular Diseases in Women in the United Kingdom

Nicola J Adderley  1 , Anuradhaa Subramanian  1 , Krishnarajah Nirantharakumar  1   2   3 , Andreas Yiangou  4   5 , Krishna M Gokhale  1 , Susan P Mollan  4   6 , Alexandra J Sinclair  4   5
Affiliations

Association Between Idiopathic Intracranial Hypertension and Risk of Cardiovascular Diseases in Women in the United Kingdom

Nicola J Adderley et al. JAMA Neurol. .

Abstract

Importance: Cardiovascular disease (CVD) risk has not been previously evaluated in a large matched cohort study in idiopathic intracranial hypertension (IIH).

Objectives: To estimate the risk of composite cardiovascular events, heart failure, ischemic heart disease, stroke/transient ischemic attack (TIA), type 2 diabetes, and hypertension in women with idiopathic intracranial hypertension and compare it with the risk in women, matched on body mass index (BMI) and age, without the condition; and to evaluate the prevalence and incidence of IIH.

Design, setting, and participants: This population-based matched controlled cohort study used 28 years of data, from January 1, 1990, to January 17, 2018, from The Health Improvement Network (THIN), an anonymized, nationally representative electronic medical records database in the United Kingdom. All female patients aged 16 years or older were eligible for inclusion. Female patients with IIH (n = 2760) were included and randomly matched with up to 10 control patients (n = 27 125) by BMI and age.

Main outcomes and measures: Adjusted hazard ratios (aHRs) of cardiovascular outcomes were calculated using Cox regression models. The primary outcome was a composite of any CVD (heart failure, ischemic heart disease, and stroke/TIA), and the secondary outcomes were each CVD outcome, type 2 diabetes, and hypertension.

Results: In total, 2760 women with IIH and 27 125 women without IIH were included. Age and BMI were similar between the 2 groups, with a median (interquartile range) age of 32.1 (25.6-42.0) years in the exposed group and 32.1 (25.7-42.1) years in the control group; in the exposed group 1728 women (62.6%) were obese, and in the control group 16514 women (60.9%) were obese. Higher absolute risks for all cardiovascular outcomes were observed in women with IIH compared with control patients. The aHRs were as follows: composite cardiovascular events, 2.10 (95% CI, 1.61-2.74; P < .001); heart failure, 1.97 (95% CI, 1.16-3.37; P = .01); ischemic heart disease, 1.94 (95% CI, 1.27-2.94; P = .002); stroke/TIA, 2.27 (95% CI, 1.61-3.21; P < .001); type 2 diabetes, 1.30 (95% CI, 1.07-1.57; P = .009); and hypertension, 1.55 (95% CI, 1.30-1.84; P < .001). The incidence of IIH in female patients more than tripled between 2005 and 2017, from 2.5 to 9.3 per 100 000 person-years. Similarly, IIH prevalence increased in the same period, from 26 to 79 per 100 000 women. Incidence increased markedly with BMI higher than 30.

Conclusions and relevance: Idiopathic intracranial hypertension in women appeared to be associated with a 2-fold increase in CVD risk; change in patient care to modify risk factors for CVD may reduce long-term morbidity for women with IIH and warrants further evaluation.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Nirantharakumar reported personal fees from Sanofi, Merck Sharp & Dohme Corp, and Boehringer Ingelheim as well as grants from AstraZeneca, National Institute for Health Research (NIHR), Health Data Research UK (Medical Research Council), and British Heart Foundation outside of the submitted work. Dr Subramanian reported grants from AstraZeneca outside of the submitted work. Dr Mollan reported personal fees from Roche, Santen, Allergan, Santhera, and Chugai outside of the submitted work. Dr Sinclair reported grant NIHR-CS-011-028 from the NIHR Clinician Scientist Fellowship, grant MR/K015184/1 from the Medical Research Council, and Registered Charity in England and Wales grant 1143522 and Scotland grant SCO43294 from the Idiopathic Intracranial Hypertension UK Charity. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Prevalence and Incidence of Idiopathic Intracranial Hypertension in Female Patients, 2005-2017
Body mass index is calculated as weight in kilograms divided by height in meters squared. Townsend deprivation quintile scale: 1-5, with 1 being least deprived and 5 most deprived.
Figure 2.
Figure 2.. Composite Outcomes Among Women With or Without Idiopathic Intracranial Hypertension
CVD indicates cardiovascular disease; HR, hazard ratio; IHD, ischemic heart disease; and TIA, transient ischemic attack.
Figure 3.
Figure 3.. Cardiometabolic Outcomes in Women With (Exposed) or Without (Control) Idiopathic Intracranial Hypertension
CVD, cardiovascular disease; IHD, ischemic heart disease; and TIA, transient ischemic attack.
See this image and copyright information in PMC

References

    1. Markey KA, Mollan SP, Jensen RH, Sinclair AJ. Understanding idiopathic intracranial hypertension: mechanisms, management, and future directions. Lancet Neurol. 2016;15(1):78-91. doi:10.1016/S1474-4422(15)00298-7 - DOI - PubMed
    1. Mulla Y, Markey KA, Woolley RL, Patel S, Mollan SP, Sinclair AJ. Headache determines quality of life in idiopathic intracranial hypertension. J Headache Pain. 2015;16:521. doi:10.1186/s10194-015-0521-9 - DOI - PMC - PubMed
    1. Mollan S, Aguiar M, Evison F, Frew E, Sinclair AJ. The expanding burden of idiopathic intracranial hypertension. Eye (Lond). 2019;33(3):478-485. doi:10.1038/s41433-018-0238-5 - DOI - PMC - PubMed
    1. Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology. 2013;81(13):1159-1165. doi:10.1212/WNL.0b013e3182a55f17 - DOI - PubMed
    1. Mollan SP, Davies B, Silver NC, et al. . Consensus guidance for adult idiopathic intracranial hypertension. J Neurol Neurosurg Psychiatry. 2018;89(10):1088-1100. doi:10.1136/jnnp-2017-317440 - DOI - PMC - PubMed