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Multifocal fibromuscular dysplasia likely benign in older people

June 26, 2018

By Marilynn Larkin

NEW YORK (Reuters Health) - Patients diagnosed with fibromuscular dysplasia (FMD) at age 65 or older are likely to have a more benign clinical presentation, with fewer symptoms, than younger patients, researchers say.

FMD, a nonatherosclerotic arterial disease that mainly affects women, is usually diagnosed in middle age, according to the authors. How the disease affects those diagnosed at an older age was not well understood.

To investigate, Dr. Heather Gornik of Cleveland Clinic Heart and Vascular Institute in Ohio and colleagues studied 1,016 participants in the US Registry for FMD, including 170 (16.7%) who were 65 years or older at the time of diagnosis.

As reported online June 20 in JAMA Cardiology, older patients were more likely to be asymptomatic at the time of diagnosis (4.2% vs. 1.4%, respectively).

Two common manifestations of FMD were less common in older patients: headache (40.5% vs. 69.1%) and pulsatile tinnitus (30% vs. 44.6%).

Extracranial carotid arteries were more commonly involved in older patients (87% vs. 79.4%). No differences in prevalence between the groups were observed for renal artery involvement, number of arterial beds involved, or aneurysm diagnosis.

Older patients were less likely to have had a major vascular event (37.1% vs. 46.1%) or to have undergone a therapeutic vascular procedure (18.5% vs. 33.1%).

"The findings truly support the fact that FMD is a vascular disease that can present across the lifespan and is not only a disease of younger women," Dr. Gornik told Reuters Health.

FMD in older patients "may be found when imaging studies are done to evaluate for abnormal physical findings, such as a carotid bruit, or as an incidental finding on an imaging study for another indication," she said by email.

"FMD should be considered in the differential diagnosis even in elderly patients, when there are classic symptoms such as pulsatile tinnitus or resistant hypertension, or bruits on physical examination," she said.

"Our study suggests that patients diagnosed with FMD in their senior years can be reassured that they are likely to have a more benign course and will do well with medical therapy alone," she added. "They are also less likely to need procedures."

Dr. Nicole Weinberg, a cardiologist at Providence Saint John's Health Center in Santa Monica, California, agreed with the findings. "This is a very unusual condition in the 65 and older cohort and that the presentation and course of disease is more mild is not surprising," she said in an email to Reuters Health.

"Younger patients who get this diagnosis generally have more compromise with their symptoms and the progression of disease is usually more problematic," she concluded.


JAMA Cardiol 2018.

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