Article: "Rare" Artery Disease Undiagnosed in Millions

A dangerous artery disease once thought to be rare puts more than 5 million Americans at risk for strokes and life-threatening aneurysms, according to a new study presented at the 24th International Symposium on Endovascular Therapy (ISET).

Fibromuscular dysplasia (FMD) has been called “the most common disease you’ve never heard of” and frequently goes undiagnosed because few doctors know how to look for it. It’s often missed until patients have a stroke or mini-stroke (also known as a transient ischemic attack or TIA) or undergo imaging tests for other disorders.

“It’s important to diagnose the disease because 20 percent of people who have FMD have an aneurysm somewhere in their body which could leak or burst, a life-threatening condition,” said researcher Jeffrey W. Olin, D.O., director of vascular medicine at the Mount Sinai School of Medicine, New York. “Doctors need to look for FMD, particularly in patients younger than 35 who have high blood pressure or migraine-type headaches.”

Here’s a look at FMD and how to tell if you have it.

What is fibromuscular dysplasia?

FMD causes one or more arteries to develop abnormal clusters of cells in the artery wall, which can lead to both areas of narrowing (stenosis) that restrict blood flow and ballooning areas (aneurysms). This can cause the blood vessel to look like a string of beads.

The disease is most likely to strike neck arteries and those that supply the kidneys. However, it can affect any artery in the body. More than 50 percent of people with the disease have 2 or more affected arteries, according to the Fibromuscular Dysplasia Society of America (FDSA).

How serious is FMD?

The disease can cause dangerous complications. The most common is high blood pressure, which can lead to damaged arteries and even heart failure, according to the Mayo Clinic.

Other complications include chronic kidney failure, stroke, aneurysms (bulges in arteries that can become life-threatening emergencies if they rupture), and dissected artery (a tear in an artery wall.)

Who is at risk?

The disease can strike people of any age, including kids, but is most common in women ages 30 to 50, reports the Cleveland Clinic. In fact, more than 90 percent of sufferers are women, according to Dr. Olin’s study, which analyzed data from FMD patient registries at seven U.S. medical centers.

What are the symptoms?

More than 95 percent of the 339 patients studied had one or more symptoms. The most common warning signs are: headaches, high blood pressure, rhythmic ringing in the ears, dizziness, a whooshing sound in the ears, and neck pain.

Typically, it took four years between the onset of symptoms and getting the correct diagnosis, the study found.

What causes fibromuscular dysplasia?

The cause is unknown. Factors that may play a role include hormones (since the disease is far more common in women) and genetics. Several case reports have found the disease in multiple members of the same family, including twins.

However, genes aren’t the whole story, since most people with FMD don’t have an affected relative.

How is FMD diagnosed?

Fibromuscular dysplasia can be diagnosed with imaging tests, including ultrasound, computed tomography angiography, and magnetic resonance angioplasty.

What’s the treatment?

While there’s no cure for FMD, several treatments can reduce the risk for serious complications. Depending on the symptoms, therapies can range from antiplatelet medications, such as aspirin, to drugs to lower blood pressure, relax blood vessels, and prevent headaches.

If the artery is severely narrowed, invasive procedures like balloon angioplasty may be performed to increase blood flow. For people who have developed aneurysms, treatments may include stents, coils, or surgery to remove or bypass the ballooning area of the artery.

To learn more, visit the website of the Fibromuscular Dysplasia Society of America, which offers medical information, a patient registry, and links to research studies.

http://health.yahoo.net/experts/dayinhealth/rare-artery-disease-undiagnosed-millions

ARTERY DISORDER UNDIAGNOSED IN MILLIONS Fibromuscular Dysplasia Most Likely To Strike Women, Suggests Registry

MIAMI BEACH, Fla. (January 17, 2012) – The most common disease you’ve never heard of, fibromuscular dysplasia (FMD), frequently goes undetected and can lead to high blood pressure, stroke and aneurysms. Although considered a rare disease, studies suggest close to 4 percent of Americans – more than 5 million people – have FMD. More than 90 percent of sufferers are women, and high blood pressure and headache are the most common symptoms, according to results of an FMD registry being presented at the 24th annual International Symposium on Endovascular Therapy (ISET).

FMD is an accumulation of fibrous tissue in the arteries – most often those in the kidney or neck – causing them to narrow. About 80 percent of the time, FMD in the kidney arteries causes an alternating bulging and narrowing of the artery that resembles a string of beads.

Researchers at ISET are reporting on 339 registry patients enrolled at seven U.S. centers, 91 percent of whom were female. More than 95 percent of patients suffered one or more symptoms. The most common symptoms were:

  • high blood pressure (66 percent)
  • headaches (53 percent)
  • rhythmic ringing in the ears (30 percent)
  • dizziness (28 percent)
  • a whooshing sound in the ear (24 percent)
  • neck pain (22 percent)

Of all patients, 19 percent had suffered a tear in an artery, most often in the carotid (neck artery), and 17 percent had suffered an aneurysm, or bulging, most often in the renal (kidney) artery.

FMD location was assessed in 309 patients and was most common in the kidney arteries, affecting 69 percent, followed by the neck arteries, affecting 62 percent. Many patients have FMD in both types of arteries. FMD can occur in any artery.

FMD frequently is undiagnosed because few doctors know to look for it. It is often found by accident, when people undergo imaging for other conditions, or after a stroke or mini-stroke known as a TIA (transient ischemic attack).

“It’s important to diagnose the disease because 20 percent of people who have FMD have an aneurysm somewhere in their body which could leak or burst, a life-threatening condition,” said Jeffrey W. Olin, D.O., director of vascular medicine at the Mount Sinai School of Medicine, New York. “Doctors need to look for FMD, particularly in patients younger than 35 who have high blood pressure or migraine-type headaches.”

FMD can be diagnosed with ultrasound, angiography, computed tomography angiography (CTA) and magnetic resonance angiography (MRA). Narrowing of the kidney arteries is treated with angioplasty, in which a tiny tube (catheter) is inserted in the groin artery and advanced to the kidney artery, where a small balloon is inflated to open up the narrowed artery. Stents are not necessary, nor recommended. If FMD in the kidney arteries is treated early enough, angioplasty often can cure the high blood pressure, said Dr. Olin. Angioplasty also can be performed in people with narrowing of the neck arteries who have symptoms. Many patients also take high blood pressure medicine or antiplatelet therapy, such as aspirin or prescription medications.

Untreated, FMD can lead to a tear in the artery and can be deadly. FMD in the renal arteries on rare occasions can lead to permanent kidney damage.

Although it is unclear what causes FMD, about 10 to 12 percent of people with the condition have a close relative who has it, Dr. Olin said. “There are many, many unanswered questions about FMD,” said Dr. Olin. “We’re hopeful information gathered through the registry will help us answer those questions, spread the word about how common this condition is and help people get treatment earlier.”

About the International Symposium on Endovascular Therapy (ISET) Begun in 1989 and led by acclaimed interventionist Barry Katzen, M.D., ISET is attended annually by physicians, scientists, allied health professionals and industry professionals from around the world. The meeting pioneered the use of live case demonstrations as an educational tool and promotes the multidisciplinary treatment of cardiac and vascular disease by endovascular means. ISET 2012 will take place Jan. 15–19 at the Fontainebleau Miami Beach. For more information, go to http://www.iset.org.

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Editor’s note: Study numbers are current as of Jan. 8, 2012 and may change upon presentation at the ISET meeting.

Copies of ISET 2012 news releases are available online at www.ISETnews.org.

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