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

Educational Objective
To determine whether the risk of cardiovascular disease is greater in woman with idiopathic intracranial hypertension compared with women with similar age and body mass index but without idiopathic intracranial hypertension.
1 Credit CME
Key Points

Question  Is the risk of cardiovascular disease greater in women with idiopathic intracranial hypertension than in women of the same age and body mass index but without idiopathic intracranial hypertension?

Findings  In this population-based matched controlled cohort study of 2760 female patients with idiopathic intracranial hypertension and 27 125 control patients, women with this condition had twice the risk for cardiovascular disease compared with their counterparts with similar body mass index and age. Between 2005 and 2017, the incidence and prevalence of idiopathic intracranial hypertension have tripled.

Meaning  Idiopathic intracranial hypertension appeared to be a risk factor for cardiovascular disease in women; changing patient management to address the risk factors for cardiovascular disease may reduce long-term morbidity.

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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Article Information

Accepted for Publication: April 26, 2019.

Published Online: July 8, 2019. doi:10.1001/jamaneurol.2019.1812

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2019 Adderley NJ et al. JAMA Neurology.

Corresponding Author: Alexandra J. Sinclair, PhD, Metabolic Neurology, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, United Kingdom (A.B.Sinclair@bham.ac.uk).

Author Contributions: Dr Adderley and Ms Subramanian had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Adderley and Nirantharakumar and Ms Subramanian contributed equally and are joint first coauthors.

Concept and design: Adderley, Nirantharakumar, Sinclair.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: Adderley, Nirantharakumar, Yiangou, Mollan, Sinclair.

Statistical analysis: Adderley, Subramanian, Nirantharakumar, Yiangou, Gokhale.

Obtained funding: Sinclair.

Administrative, technical, or material support: Adderley, Nirantharakumar, Yiangou, Gokhale.

Supervision: Nirantharakumar, Mollan, Sinclair.

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.

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