Tuesday, February 25, 2014

Vascular disease affecting mostly women 'poorly understood'

AHA details latest on diagnosis and treatment of fibromuscular dysplasia

MAYWOOD, Ill.  – A vascular disease called fibromuscular dysplasia, which can cause high blood pressure, kidney failure, stroke and other symptoms -mostly in women, is “poorly understood by many health-care providers,” according to a scientific statement from the American Heart Association.

Neurologist José Biller, MD, of Loyola University Medical Center, is a co-author of the statement, published online ahead of the print version in the American Heart Association journal Circulation. First author is Jeffrey W. Olin, DO, of the Icahn School of Medicine at Mount Sinai.

Biller said FMD “is a relatively uncommon and often undiagnosed arterial condition of unknown cause."

Biller is an internationally known stroke specialist and chair of the Department of Neurology of Loyola University Chicago Stritch School of Medicine. He is a member of the multidisciplinary group of vascular experts who wrote the American Heart Association’s scientific statement on fibromuscular dysplasia (FMD).

FMD can cause narrowing, enlargement, bulging or tears in medium-size arteries. FMD occurs most commonly in arteries leading to the kidneys and in carotid arteries in the neck that carry blood to the brain and eyes. It also can affect arteries supplying blood to the abdominal organs, legs or arms.

Neurological complications include headaches, neck pain, tinnitus (swishing sounds in the ears), strokes and transient ischemic attacks (mini strokes). FMD may be a predisposing condition for cervical arterial dissections (tears in neck arteries). It also can cause brain aneurysms or bleeding on the surface of the brain.

FMD “is poorly understood by many health-care providers,” the scientific statement said. A delay in diagnosis “can lead to impaired quality of life and poor outcomes."

The condition was first described in a medical journal in 1938 and given the name fibromuscular dysplasia in 1958.

Although the prevalence in the general population is unknown, 91 percent of patients with FMD are female, the scientific statement said. Although the cause is unknown, there appears to be a genetic basis for susceptibility to FMD.

The scientific statement lists several common misconceptions regarding FMD. One misconception is that the most common presentation for FMD in the carotid artery is a stroke or mini stroke. In fact, while strokes and mini strokes can occur with carotid FMD, the most common presentations are nonspecific symptoms such as headaches, dizziness, lightheadedness and tinnitus.

FMD often is misdiagnosed as other conditions, such as atherosclerosis and vasculitis. The gold standard for correctly diagnosing FMD is a catheter-based angiogram.

Advances in imaging and therapies “have made the treatment for patients with FMD less invasive, safer and more effective,” the scientific statement said.
But there is a great need for more research, the statement said. “Significant advances in our understanding of FMD will undoubtedly require collaboration across a large network of research and clinical centers in the United States and abroad,” the statement said.

The Fibromuscular Dysplasia Society of America praised the scientific statement. “The authors did a great job and covered all areas of FMD, including history of the disease, diagnosis, imaging, treatment and research,” the society said on its website.

About Loyola University Health System

Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system that includes Loyola University Medical Center (LUMC), located on a 61-acre campus in Maywood, Gottlieb Memorial Hospital (GMH), on a 36-acre campus in Melrose Park, and convenient locations offering primary and specialty care services throughout Cook, Will and DuPage counties. At the heart of LUMC is a 547-licensed-bed hospital that houses the Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, a burn center, a children's hospital, Loyola Outpatient Center, and Loyola Oral Health Center. The campus also is home to Loyola University Chicago Stritch School of Medicine, Loyola University Chicago Marcella Niehoff School of Nursing and the Loyola Center for Fitness. The GMH campus includes a 254-licensed-bed community hospital, a Professional Office Building with 150 private practice clinics, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.

Trinity Health is one of the largest multi-institutional Catholic health care delivery systems in the nation. It serves people and communities in 22 states from coast to coast with 93 hospitals, and 120 continuing care locations — including home care, hospice, PACE and senior living facilities — that provide nearly 2.5 million visits annually.