fibromuscular dysplasia support, education & advocacy
Fibromuscular dysplasia (FMD) is a complex disease that is most commonly seen in women, with systemic presentation that may include stenosis, aneurysm or dissection most commonly in the renal and carotid arteries, migraine-like headaches, dizziness, and tinnitus or a swooshing sound in the ears. Low bone density, joint laxity and degenerative disease in the spine also have been linked to the disease. FMD is considered a rare disease; however, it is also believed to be underdiagnosed.

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Connections Between Fibromuscular Dysplasia and Spontaneous Coronary Artery Dissection

Recent studies have linked two rare conditions, fibromuscular dysplasia and spontaneous coronary artery dissection.

FMD and SCAD are most commonly seen in women. FMD's presentation may include dissection or aneurysm most commonly in the renal and carotid arteries, migraine-like headaches, dizziness, and tinnitus. SCAD occurs when the inner layer of an artery tears, creating a blood clot or blockage that results in acute coronary syndrome, heart attack or sudden death. 

According to research presented at the First International FMD Research Network Symposium held at Cleveland Clinic this May, more than 40 to 50 percent of SCAD patients may also have FMD, though the prevalence is uncertain at this time, said Dr. Sharonne Hayes, who directs and practices at the Women's Heart Clinic at Mayo Clinic in Rochester, Minnesota. Research shows that SCAD patients also diagnosed with FMD are at an increased risk for dissections in many arterial beds. 

SCAD may occur with little warning. Some patients report high levels of emotional stress or physical exertion prior to experiencing a dissection, Hayes said, but for many others the cause is unclear. Research indicates FMD may be a causative factor, yet a relationship between the severity of FMD and an occurrence of SCAD has not been determined. Patients may present with minimal evidence of FMD found through only through imaging, or patients may present with bruits, a sound heard within an artery as blood rushes by an obstruction, or symptomatic extracoronary aneurysms or dissections. Recommendations are for symptomatic patients or those with a family history suggestive of significant vascular events to undergo CT angiography from neck to pelvis with additional intracranial imaging if necessary. 

Dr. Jacqueline Saw of Vancouver General Hospital reported the first case study of SCAD and concomitant coronary FMD in Circulation earlier this year. "Although not all SCAD patients have CFMD, it is important to exclude FMD, as involvement of other vascular territories have long-term consequences," the article states.

SCAD research is shaping FMD experts' knowledge of the disease and patient evaluation.

In 2002, the U.S. Preventive Services Task Force began recommending that patients at high risk of developing cardiovascular disease — acute coronary syndrome or thrombotic cerebral vascular disease — take low-dose aspirin as a primary preventative. This year the Federal Drug Administration has come out against the therapy for the prevention of heart attack or stroke; however, aspirin still is recommended for as a preventative for patients who have experienced a prior event.

The treatment presents a complex risk-benefit analysis. There is evidence to support the recommendation of up to 81 mg of aspirin daily for patients diagnosed with cerebrovascular FMD, regardless of symptoms, reported Dr. Jeffrey Olin, Director of Vascular Medicine and the Vascular Diagnostic Laboratory in the Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health of The Mount Sinai Medical Center, during the International FMD Research Network Symposium. Aspirin's use in renal FMD patients is less clear, Olin said. 

"There is no evidence that aspirin prevents SCAD, and it should not be used for primary prevention in women, whose bleeding risk from aspirin is higher than men, and in the case of an undiagnosed cerebral aneurysm in an FMD patient could be catastrophic," Hayes said. 

Given these recent findings, FMD Chat is collaborating with the SCAD Alliance to provide more information about the diseases' overlaps. 

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