Idiopathic Intracranial Hypertension and Cardiovascular Diseases Risk in the United Kingdom Women: An Obesity-Adjusted Risk Analysis Using Indirect Standardization

Ahmed Y. Azzam; Mahmoud M. Morsy; Mohamed Hatem Ellabban; Ahmed M. Morsy; Adham Adel Zahran; Mahmoud Nassar; Omar S. Elsayed; Adam Elswedy; Osman Elamin; Ahmed Saad Al Zomia; Hana J. Abukhadijah Abukhadijah; Hammam A. Alotaibi Alotaibi; Oday Atallah; Mohammed A. Azab; Muhammed Amir Essibayi; Adam A. Dmytirw; Mohamed D. Morsy; David J. Altschul

doi:10.71079/h1fr8h68

Authors

Ahmed Y. Azzam Faculty of Medicine, October 6 University, 6th of October City, Giza, Egypt. Director of Clinical Research and Clinical Artificial Intelligence, American Society for Inclusion, Diversity, and Health Equity (ASIDE), Delaware, USA. Montefiore-Einstein Cerebrovascular Research Lab, Albert Einstein College of Medicine, Bronx, NY, USA. Author https://orcid.org/0000-0002-4256-0159
Mahmoud M. Morsy Faculty of Medicine, October 6 University, 6th of October City, Giza, Egypt. Clinical Research Fellow, American Society for Inclusion, Diversity, and Health Equity (ASIDE), Delaware, USA. Author https://orcid.org/0009-0001-4356-5306
Mohamed Hatem Ellabban Faculty of Medicine, Al-Azhar University, Cairo, Egypt. Author https://orcid.org/0009-0005-0012-3574
Ahmed M. Morsy Cairo University Hospitals, Cairo, Egypt Author
Adham Adel Zahran Kasr Alainy Faculty of Medicine, Cairo University Hospitals, Cairo University, Cairo, Egypt. Author
Mahmoud Nassar Founder, American Society for Inclusion, Diversity, and Health Equity (ASIDE), Delaware, USA. Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA. Author https://orcid.org/0000-0002-5401-9562
Omar S. Elsayed Faculty of Medicine, October 6 University, 6th of October City, Giza, Egypt. Author https://orcid.org/0009-0000-4635-6545
Adam Elswedy Faculty of Medicine, October 6 University, 6th of October City, Giza, Egypt. Author https://orcid.org/0009-0008-0154-0507
Osman Elamin Department of Neurosurgery, Jordan Hospital, Amman, Jordan. Author https://orcid.org/0000-0002-7845-2192
Ahmed Saad Al Zomia College of Medicine, King Khalid University, Abha, Saudi Arabia Author https://orcid.org/0000-0002-7850-7229
Hana J. Abukhadijah Medical Research Center, Hamad Medical Corporation, Doha, Qatar. Author https://orcid.org/0009-0008-7993-7467
Hammam A. Alotaibi Ophthalmology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia. Author
Oday Atallah Department of Neurosurgery, Hannover Medical School, Hannover, Germany. Author https://orcid.org/0000-0002-3131-4104
Mohammed A. Azab Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA. Author https://orcid.org/0000-0002-3519-9035
Muhammed Amir Essibayi Montefiore-Einstein Cerebrovascular Research Lab, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA. Author https://orcid.org/0000-0001-8325-2382
Adam A. Dmytirw Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, USA. Neurovascular Centre, Divisions of Therapeutic Neuroradiology & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada. Author https://orcid.org/0000-0003-0131-5699
Mohamed D. Morsy College of Medicine, King Khalid University, Abha, Saudi Arabia. Author https://orcid.org/0000-0002-9205-9338
David J. Altschul Montefiore-Einstein Cerebrovascular Research Lab, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA. Author https://orcid.org/0000-0002-5130-1378

DOI:

https://doi.org/10.71079/h1fr8h68

Keywords:

Idiopathic Intracranial Hypertension, Pseudotumor Cerebri, Stroke, Ischemic Stroke, Cardiovascular Disease

Abstract

Introduction: Idiopathic intracranial hypertension (IIH) is known to elevate cardiovascular disease (CVD) risk, but the extent to which obesity and IIH-specific factors contribute to this risk is not well understood. WE aim to separate the effects of obesity from IIH-specific factors on the risk of stroke and CVD, building on previous findings that indicate a two-fold increase in cardiovascular events in women with IIH compared to BMI-matched controls.

Methods: An obesity-adjusted risk analysis was conducted using Indirect Standardization based on data from a cohort study by Adderley et al., which included 2,760 women with IIH and 27,125 matched healthy controls from The Health Improvement Network (THIN). Advanced statistical models were employed to adjust for confounding effects of obesity and determine the risk contributions of IIH to ischemic stroke and CVD, independent of obesity. Four distinct models explored the interactions between IIH, obesity, and CVD risk.

Results: The analysis showed that IIH independently contributes to increased cardiovascular risk beyond obesity alone. Risk ratios for cardiovascular outcomes were significantly higher in IIH patients compared to controls within similar obesity categories. Notably, a synergistic effect was observed in obese IIH patients, with a composite CVD risk ratio of 6.19 (95% CI: 4.58-8.36, p<0.001) compared to non-obese controls.

Conclusions: This study underscores a significant, independent cardiovascular risk from IIH beyond obesity. The findings advocate for a shift in managing IIH to include comprehensive cardiovascular risk assessment and mitigation. Further research is required to understand the mechanisms and develop specific interventions for this group.

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