Cardiometabolic Outcomes in Idiopathic Intracranial Hypertension: An International Matched-Cohort Study

Overview

Journal medRxiv

Date 2024 Dec 16

PMID 39677466

Authors

Ahmed Y Azzam

Muhammed Amir Essibayi

Dhrumil Vaishnav

Mahmoud M Morsy

Osman Elamin

Ahmed Saad Al Zomia

Hammam A Alotaibi

Ahmed Alamoud

Adham A Mohamed

Omar S Ahmed

Adam Elswedy

Hana J Abukhadijah

Oday Atallah

Adam A Dmytriw

David J Altschul

Affiliations

Soon will be listed here.

Abstract

Introduction: Idiopathic intracranial hypertension (IIH) has been traditionally viewed as a neuro-ophthalmic disorder, yet emerging evidence suggests broader systemic implications. Our study investigates the cardiometabolic outcomes associated with IIH through a comprehensive matched-cohort analysis.

Methods: We conducted a retrospective analysis of electronic health records from 2009 to 2024. We compared IIH patients with matched controls using propensity score matching based on age, sex, race, ethnicity, and baseline BMI. Cardiovascular and metabolic outcomes were assessed over a ten-year follow-up period, with additional stratified analyses comparing obese and non-obese subgroups.

Results: IIH patients demonstrated significantly increased risks of ischemic stroke/TIA (RR 2.515, 95% CI 2.250-2.812) and non-traumatic hemorrhagic stroke (RR 7.744, 95% CI 6.118-9.801). Notable metabolic findings included elevated risks of insulin resistance (RR 1.470, 95% CI 1.258-1.717) and type 2 diabetes mellitus (RR 1.210, 95% CI 1.171-1.250). These associations persisted in non-obese IIH patients, suggesting pathogenic mechanisms independent of adiposity. Additionally, IIH patients showed increased prevalence of polycystic ovarian syndrome (RR 1.470, 95% CI 1.258-1.717) and metabolic syndrome (RR 1.125, 95% CI 1.045-1.205).

Conclusions: Our findings highlight IIH as a complex multisystem disorder with significant cardiometabolic implications beyond its traditional neuro-ophthalmic presentation. The findings suggest the need for comprehensive cardiovascular and metabolic screening in IIH patients, regardless of BMI status, and indicate potential novel therapeutic targets for investigation.

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