Idiopathic Intracranial Hypertension and Cardiovascular Diseases Risk in the United Kingdom Women: An Obesity-Adjusted Risk Analysis Using Indirect Standardization
Keywords:
Idiopathic Intracranial Hypertension, Pseudotumor Cerebri, Stroke, Ischemic Stroke, Cardiovascular DiseaseAbstract
Introduction: Idiopathic intracranial hypertension (IIH) is associated with increased cardiovascular disease (CVD) risk, but the relative contributions of obesity versus IIH-specific factors remain unclear. This study aims to disentangle the effects of obesity and IIH on stroke and CVD risk, building upon previous research suggesting a two-fold increased risk of cardiovascular events in women with IIH compared to BMI-matched controls.
Methods: We conducted an obesity-adjusted risk analysis using Indirect Standardization analysis based on Adderley et al. study which utilized data from a cohort of 2,760 women with IIH and 27,125 matched healthy controls from The Health Improvement Network (THIN) database. We employed innovative statistical models to adjust for the confounding effects of obesity, estimating the risk of ischemic stroke and cardiovascular disease attributable to IIH independent of obesity. Four distinct models were used to elucidate the complex interrelationships between IIH, obesity, and CVD risk.
Results: Our analysis revealed that IIH confers additional cardiovascular risk beyond that attributed to obesity alone. Risk ratios for various cardiovascular outcomes were consistently elevated across models comparing IIH patients to controls within the same obesity strata. A striking synergistic effect between IIH and obesity was observed, with the composite CVD risk reaching a risk ratio of 6.19 (95% CI: 4.58-8.36, p<0.001) in obese IIH patients compared to non-obese controls.
Conclusions: This study provides compelling evidence for a nuanced relationship between IIH, obesity, and cardiovascular risk. IIH appears to confer substantial cardiovascular risk independent of obesity, necessitating a paradigm shift in IIH management to encompass comprehensive cardiovascular risk mitigation. Further research is needed to elucidate the underlying mechanisms and develop targeted interventions for this unique patient population.
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