Introduction/Background: Fibromuscular dysplasia (FMD) is a non-inflammatory, non-atherosclerotic arterial disease that may result in arterial stenosis, dissection, aneurysm, and tortuosity. Anxiety (A) and depression (D) are prevalent in patients with rare and uncommon diseases compared to the general population; however, there are limited data on A and D in the FMD population. This study describes characteristics of FMD patients with and without A and/or D (A/D).
Methods: Patients enrolled in the US Registry for FMD between 2009-2017 and had A/D information were analyzed (n=985). Diagnosis of A/D was ascertained from patient charts or self-reported via medical history questionnaires at time of registry enrollment. Demographics, family history, past medical history, presenting symptoms, and affected vascular beds were compared between patients with and without A/D.
Results: A total of 351 (35.6%) had A/D. Of patients with A/D, 126 (35.9%) had both. Patients with A/D were more likely to have a family history of aneurysm (33.6% v. 23.7%, p=0.001) and stroke (53.6% v. 46.1%, p=0.03), and have a medical history of hemispheric TIA (15.5% v. 10.9%, p=0.04), subarachnoid hemorrhage (4.4% v. 1.8%, p=0.015) and smoking (43% v. 28%, p<0.001). Patients with A/D were more likely to present at the time of diagnosis with headache (68.6% v. 53.8%, p<0.001), pulsatile tinnitus (42.2% v. 34%, p=0.014), dizziness (45.3% v. 29.2%, p<0.001), neck pain (40% v. 24.9%, p<0.001) and carotid/vertebral arterial dissection (21.6% v. 14.7%, p=0.007). Patients with A/D were less likely to have renal artery FMD (58.4% v. 68.9%, p=0.002). No differences in the time between symptom onset and FMD diagnosis (2.7±6.2 v. 3.1±6.9 years, p=0.89) or number of vascular beds involved (1.9±1.1 v. 1.9±1.1, p=0.77) were seen between groups.
Conclusions: More than 1/3 of patients in the FMD registry had A, D, or both, and these patients showed multiple differences compared to patients without A/D. More study is required to understand this relationship. Given the high prevalence of A/D in this population, FMD patients should be screened for the presence of A/D and offered appropriate treatment.