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Etiologic factors in renovascular fibromuscular dysplasia. A case-control study
C N Sang1, P K Whelton, U M Hamper
1Outpatient Clinical Research Center, Johns Hopkins Medical Institutions, Baltimore, MD 21205.
Insights
Cigarette smoking and a history of hypertension significantly increase the risk of developing renovascular fibromuscular dysplasia. These factors, particularly smoking, are key contributors to this condition.
Area of Science:
- Nephrology
- Vascular Medicine
- Genetics
Background:
- Renovascular fibromuscular dysplasia (FMD) is a condition affecting renal arteries.
- Several potential risk factors for FMD have been proposed but not definitively established.
Purpose of the Study:
- To investigate the role of various factors in the etiology of renovascular fibromuscular dysplasia.
- To identify significant risk factors associated with FMD development.
Main Methods:
- A case-control study comparing 33 FMD patients with 61 renal transplant donor controls.
- Analysis of factors including oral contraceptive use, sex hormone dysfunction, mechanical stress, HLA type, smoking, hypertension history, and family history of cardiovascular disease.
Main Results:
- Cigarette smoking was significantly associated with increased FMD risk (OR=4.1, p=0.003), with a dose-response effect (OR=8.6 for >10 pack-years).
- A history of hypertension (>5 years) also significantly increased FMD risk (OR=5.0, p=0.036).
- HLA-DRw6 antigen was more prevalent in FMD patients (OR=2.51, p=0.031), with adjusted OR=5.0 after accounting for smoking.
Conclusions:
- Cigarette smoking and long-standing hypertension are significant risk factors for renovascular fibromuscular dysplasia.
- HLA-DRw6 may also play a role, independent of smoking.
- Further research into the multifactorial etiology of FMD is warranted.
Abstract:
The role of several factors that have been suggested as being of etiologic importance in renovascular fibromuscular dysplasia was examined in a case-control study of 33 patients with angiographically demonstrated fibromuscular dysplasia and 61 renal transplant donor control subjects with normal renal arteries. The factors studied included use of oral contraceptive agents or markers of sex hormone dysfunction, mechanical stress to the renal artery wall, human lymphocytic antigen (HLA) type, cigarette smoking, history of hypertension for more than 5 years, and family history of cardiovascular disease. The risk of fibromuscular dysplasia was significantly (p = 0.003) increased (odds ratio = 4.1, 95% confidence interval = 1.5-10.9) among cigarette smokers. A significant (p less than 0.001) dose-response relation was noted between cigarette use and the risk of fibromuscular dysplasia developing (odds ratio = 8.6 for those who had smoked more than 10 pack-years). Personal history of hypertension more than 5 years was also associated (odds ratio = 5.0, 95% confidence interval = 1.1-22.8) with a significantly (p = 0.036) increased risk for the development of fibromuscular dysplasia. HLA-DRw6 antigen was more common in the 33 fibromuscular dysplasia patients than in the 61 renal transplant donor control subjects (odds ratio = 3.00, p = 0.067) or a second group of 934 ambulatory control subjects (odds ratio = 2.51, p = 0.031). Adjustment for cigarette smoking increased the odds ratio to 5.0 (95% confidence interval = 1.3-19.6). There was a positive though not statistically significant (odds ratio = 1.7, p = 0.175) association noted between family history of cardiovascular disease and fibromuscular dysplasia.(ABSTRACT TRUNCATED AT 250 WORDS)