Pub Date : 2025-01-01Epub Date: 2024-11-17DOI: 10.71079/h1fr8h68
Ahmed Y Azzam, Mahmoud M Morsy, Mohamed Hatem Ellabban, Ahmed M Morsy, Adham Adel Zahran, Mahmoud Nassar, Omar S Elsayed, Adam Elswedy, Osman Elamin, Ahmed Saad Al Zomia, Hana J Abukhadijah, Hammam A Alotaibi, Oday Atallah, Mohammed A Azab, Muhammed Amir Essibayi, Adam A Dmytriw, Mohamed D Morsy, David J Altschul
Introduction: Idiopathic intracranial hypertension (IIH) is known to elevate cardiovascular disease (CVD) risk, but the extent to which obesity and IIH-specific factors contribute to this risk is not well understood. WE aim to separate the effects of obesity from IIH-specific factors on the risk of stroke and CVD, building on previous findings that indicate a two-fold increase in cardiovascular events in women with IIH compared to BMI-matched controls.
Methods: An obesity-adjusted risk analysis was conducted using Indirect Standardization based on data from a cohort study by Adderley et al., which included 2,760 women with IIH and 27,125 matched healthy controls from The Health Improvement Network (THIN). Advanced statistical models were employed to adjust for confounding effects of obesity and determine the risk contributions of IIH to ischemic stroke and CVD, independent of obesity. Four distinct models explored the interactions between IIH, obesity, and CVD risk.
Results: The analysis showed that IIH independently contributes to increased cardiovascular risk beyond obesity alone. Risk ratios for cardiovascular outcomes were significantly higher in IIH patients compared to controls within similar obesity categories. Notably, a synergistic effect was observed in obese IIH patients, with a composite CVD risk ratio of 6.19 (95% CI: 4.58-8.36, p<0.001) compared to non-obese controls.
Conclusions: This study underscores a significant, independent cardiovascular risk from IIH beyond obesity. The findings advocate for a shift in managing IIH to include comprehensive cardiovascular risk assessment and mitigation. Further research is required to understand the mechanisms and develop specific interventions for this group.
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Pub Date : 2025-01-01Epub Date: 2024-12-28DOI: 10.71079/2024001001
Ahmed Y Azzam, Mahmoud Nassar, Ahmed Saad Al Zomia, Adam Elswedy, Mahmoud M Morsy, Adham A Mohamed, Osman Elamin, Omar S Elsayed, Mohammed A Azab, Muhammed Amir Essibayi, Jin Wu, Adam A Dmytirw, David J Altschul
Introduction: Managing idiopathic intracranial hypertension (IIH) is challenging due to limited treatment options. This study evaluates metformin as a potential therapy for IIH, examining its impact on disease outcomes and safety.
Methods: We performed a retrospective cohort study using the TriNetX database, covering data from 2009 to August 2024. The study included IIH patients, excluding those with other causes of raised intracranial pressure or pre-existing diabetes. Propensity score matching adjusted for age, sex, race, ethnicity, Hemoglobin A1C, and baseline BMI at metformin initiation. We assessed outcomes up to 24 months.
Results: Initially, 1,268 patients received metformin and 49,262 served as controls, showing disparities in various parameters. After matching, both groups consisted of 1,267 patients each. Metformin users had significantly lower risks of papilledema, headache, and refractory IIH at all follow-ups (p<0.0001). They also had fewer spinal punctures and reduced acetazolamide use. BMI reductions were more significant in the metformin group from 6 months onward (p<0.0001), with benefits persisting regardless of BMI changes. Metformin's safety profile was comparable to the control group.
Conclusions: The study indicates metformin's potential as a disease-modifying treatment in IIH, with improvements across multiple outcomes independent of weight loss. This suggests complex mechanisms at play, supporting further research through prospective clinical trials to confirm metformin's role in IIH management and its mechanisms of action.
{"title":"Safety and Efficacy of Metformin for Idiopathic Intracranial Hypertension. A U.S-Based Real-World Data Retrospective Multicenter Cohort Study.","authors":"Ahmed Y Azzam, Mahmoud Nassar, Ahmed Saad Al Zomia, Adam Elswedy, Mahmoud M Morsy, Adham A Mohamed, Osman Elamin, Omar S Elsayed, Mohammed A Azab, Muhammed Amir Essibayi, Jin Wu, Adam A Dmytirw, David J Altschul","doi":"10.71079/2024001001","DOIUrl":"10.71079/2024001001","url":null,"abstract":"<p><strong>Introduction: </strong>Managing idiopathic intracranial hypertension (IIH) is challenging due to limited treatment options. This study evaluates metformin as a potential therapy for IIH, examining its impact on disease outcomes and safety.</p><p><strong>Methods: </strong>We performed a retrospective cohort study using the TriNetX database, covering data from 2009 to August 2024. The study included IIH patients, excluding those with other causes of raised intracranial pressure or pre-existing diabetes. Propensity score matching adjusted for age, sex, race, ethnicity, Hemoglobin A1C, and baseline BMI at metformin initiation. We assessed outcomes up to 24 months.</p><p><strong>Results: </strong>Initially, 1,268 patients received metformin and 49,262 served as controls, showing disparities in various parameters. After matching, both groups consisted of 1,267 patients each. Metformin users had significantly lower risks of papilledema, headache, and refractory IIH at all follow-ups (p<0.0001). They also had fewer spinal punctures and reduced acetazolamide use. BMI reductions were more significant in the metformin group from 6 months onward (p<0.0001), with benefits persisting regardless of BMI changes. Metformin's safety profile was comparable to the control group.</p><p><strong>Conclusions: </strong>The study indicates metformin's potential as a disease-modifying treatment in IIH, with improvements across multiple outcomes independent of weight loss. This suggests complex mechanisms at play, supporting further research through prospective clinical trials to confirm metformin's role in IIH management and its mechanisms of action.</p>","PeriodicalId":520384,"journal":{"name":"ASIDE internal medicine","volume":"1 1","pages":"12-19"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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