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

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
  • 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
  • Mohamed Hatem Ellabban Faculty of Medicine, Al-Azhar University, Cairo, Egypt. Author
  • Ahmed M. Morsy 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
  • Adam Elswedy Faculty of Medicine, October 6 University, 6th of October City, Giza, Egypt. Author
  • Osman Elamin Department of Neurosurgery, Jordan Hospital, Amman, Jordan. Author
  • Ahmed Saad Al Zomia College of Medicine, King Khalid University, Abha, Saudi Arabia Author
  • Hana J. Abukhadijah Medical Research Center, Hamad Medical Corporation, Doha, Qatar. Author
  • 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
  • Mohammed A. Azab Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA. Author
  • 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
  • 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
  • Mohamed D. Morsy College of Medicine, King Khalid University, Abha, Saudi Arabia. Author
  • 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

Keywords:

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

Abstract

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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2024-11-27

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Idiopathic Intracranial Hypertension and Cardiovascular Diseases Risk in the United Kingdom Women: An Obesity-Adjusted Risk Analysis Using Indirect Standardization. (2024). ASIDE Internal Medicine, 1(1). https://asidejournals.com/index.php/internal-medicine/article/view/2

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