FibromuscularDysplasia

What is fibromuscular dysplasia (FMD)?

Fibromuscular Dysplasia (FMD) is a vascular disease that can make the artery walls too weak or too stiff. This can lead to the arteries being either narrowed, known as stenosis, or become enlarged, otherwise known as aortic aneurysm. FMD patients can also suffer from artery dissections – which is akin to the sudden tearing of the artery wall.

FMD can affect any medium-sized blood vessel in the body, though it is most commonly found in the arteries that supply the kidneys, and the carotid and vertebral arteries that supply the brain with blood.

It can vary in severity; some women may have little or no symptoms. For others, it can lead to serious complications including stroke and heart attack.

How common is FMD?

Fibromuscular Dysplasia (FMD) was once thought to be rare, but as more is learned about the disease, it is now thought to affect up to one in 20 Australian women. Most women have mild or no symptoms. The average age for diagnosis is around 50-55 years old and 95% of people with FMD are women.

What causes FMD?

Genetics is thought to be a major factor in determining if you develop Fibromuscular Dysplasia (FMD). Working with teams from around the world, the Institute’s Professor Jason Kovacic has identified the five key genes responsible for FMD. It is hoped this work will lead to genetic testing and potentially new treatments in the future.

It is believed that female hormones may also play a role.

What are the symptoms of FMD?

Symptoms and signs can vary depending on which artery is being blocked.

For those whose kidneys are affected, symptoms can include:

• High blood pressure
• Abnormal kidney function, or rarely even kidney failure
• Shrinkage of the kidney known as atrophy

FMD in the carotid arteries may cause the following symptoms:

• Pulsatile tinnitus – a ‘wooshing’ sound in the ears
• Headaches – especially migraines
• Neck pain
• Ringing in your ears
• Dizziness
• Stroke

Is there a cure for FMD?

There is no cure for FMD but if detected early, FMD can be managed, and many women can live long and healthy lives well into their 80s and 90s.

How is FMD diagnosed?

FMD can be diagnosed with tests that image the blood vessels, which include a specialized blood vessel ultrasound, a CT scan of the arteries, or a type of MRI. Of these, the CT scan of the arteries (more properly called a CT angiogram) is usually preferred.

A diagnosis of FMD may also sometimes need a procedure called an invasive angiogram, a test that uses x-rays and dye to see inside the arteries and involves a catheter inserted usually via the groin area. This is considered the gold standard for diagnosing FMD.

How can it be treated?

Treatment is all about managing the symptoms which can vary depending on which artery is affected. This often can include anti-clotting and blood pressure-lowering medications but can also include therapies for migraine.

Common medications include ACE inhibitors (or angiotensin-converting enzyme inhibitors) and ARBs (angiotensin-receptor blockers) which are used to treat high blood pressure, reduce the risk of stroke, or prevent kidney failure. A “baby” aspirin (75 – 100mg) daily is often also prescribed for FMD patients to prevent blood clots.

People with FMD should also stop smoking, cut down on salt, eat a healthy diet and engage in exercise – all of which can help reduce the risk of vascular complications and should be adopted by the larger population at large too.

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