FMD: A Hidden, Often-Missed Stroke Threat for Middle-Aged Women

Little-known vascular disease also can leave you vulnerable to severe high blood pressure
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Fibromuscular dysplasia (FMD) is a little-known form of vascular disease that leaves people vulnerable to stroke and severe high blood pressure in the prime of life.

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Unfortunately, many doctors are unfamiliar with this disease, which tends to affect younger and middle-aged patients. More than 90 percent of people diagnosed with FMD are women.

These patients are primarily women who are otherwise healthy and the symptoms are fairly common. So her doctor is unlikely to suspect a woman may have FMD when she complains of migraine headaches, dizziness or a swooshing noise in the ears, or develops high blood pressure, says vascular medicine specialist Heather Gornik, MD.

“The diagnosis is often delayed, generally by years after symptoms develop,” she says.

What is FMD?

People with FMD have abnormal cellular growth in the walls of their medium and large arteries. This can cause the arteries with the abnormal growth to look beaded. The arteries may also maybe narrowed.  The abnormal cellular growth can also lead to weakness of the artery wall and lead to bulging of the arteries (aneurysms) or tears of the arteries (dissections) .  Dissection of arteries may lead to serious consequences, such as stroke or heart attack.

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Most cases of FMD affect the carotid arteries in the neck, which connect the heart and the brain, and the renal arteries, which are the blood vessels that carry blood from the aorta to the kidneys.

It’s still unclear what causes FMD, Dr. Gornik says, and it’s likely that disease has a number of causes.

Some of the factors that might play a role include hormones, genetic factors, and mechanical forces on the arteries,  she says.

Treatment options

Treatment of the disease isn’t well-defined, Dr. Gornik says. Medications can reduce the effects of high blood pressure and help prevent a heart attack and stroke.  Some patients with FMD involving the renal arteries may benefit from a balloon angioplasty procedure to improve blood flow to the kidneys and treat high blood pressure.

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Aneurysms and tears can be treated with medications, a catheter-based procedure, or surgery. But unlike atherosclerosis, which may cause a blockage in one or two locations, FMD can affect entire vessels in multiple locations, making the disease much harder to treat.

“We’ve made great strides and now have the momentum to learn more about this disease,” Dr. Gornik says. “We are hopeful our work will help identify the causes of FMD and lead to more effective treatments in the coming years.”

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