FMD: A Hidden Threat for Middle-Aged Women

Fibromuscular Dysplasia (FMD) is a little-known form of vascular disease that leaves many people vulnerable to stroke and severe high blood pressure in the prime of life.

Unfortunately, many doctors are unfamiliar with this disease, which tends to affect younger and middle-aged patients. These patients are primarily otherwise healthy women. So when a woman complains of migraine, dizziness or a swooshing noise in the ears, or develops high blood pressure, her doctor is unlikely to suspect she may have FMD.

“The diagnosis is often delayed, generally by years after symptoms develop” says Cleveland Clinic vascular medicine specialist Heather Gornik, MD, the first physician in the world to start a dedicated FMD clinic.

Everything that is known today about FMD appears in the first American Heart Association Scientific Statement on the disease. Dr. Gornik co-chaired the task force that produced the document, which was published on March 4, 2014, in Circulation.
Treatment Options

What isn’t well-known is how to treat the disease. Medications can reduce the effects of high blood pressure and help prevent a heart attack and stroke. 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.
FMD International Symposium

To further knowledge about FMD, Dr. Gornik co-hosted the first international FMD Research Network Symposium at Cleveland Clinic in May of 2014. The meeting attracted more than 90 clinicians and investigators in vascular medicine, vascular surgery, cardiology, medical genetics, neurology, nephrology and radiology from the United States, Canada and Europe.

After two days of lectures, several messages became clear:

FMD often affects blood vessels in the brain as well as the kidneys.
A blood vessel balloons (develops an aneurysm) or tears (dissects) in about one-third of FMD patients.
A tear in a coronary artery will trigger a heart attack.
Although FMD can cause many problems, it is rarely fatal.
How FMD is inherited is unknown.

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