Objective:

Background:

FMD is a non-atherosclerotic, non-inflammatory vasculopathy associated with cerebrovascular complications. Primary prevention of stroke in patients with FMD remains controversial despite consensus guidelines recommending daily aspirin.

Design/Methods:

This retrospective case-control study identified adults with FMD using a de-identified, aggregate medical record database at a single medical center. Exclusions included diagnoses of malignancy, thrombophilia, connective tissue disease, prior myocardial infarction, or stroke before FMD diagnosis. The outcome of interest was ischemic stroke, while variables of interest were antecedent aspirin or statin use. Multivariable logistic regression was conducted, controlling for age and sex, to determine odds ratios (ORs) and associated 95% confidence intervals.

Results:

Of 1053 eligible patients with FMD, 806 (76.5%) were on aspirin, and 593 (56.3%) on statins. Ischemic stroke followed FMD diagnosis in 30 (2.8%) patients. Aspirin use was associated with decreased odds of ischemic stroke (OR: 0.33 [0.17-0.70], p-value: 0.004), with patients aged 60-69 years having the lowest odds (OR: 0.095 [0.02-0.55], p-value: 0.009), and women (OR: 0.40 [0.02-0.87], p-value: 0.021) having higher odds than men (0.061 [0.005-0.825], p-value: 0.035). Statin use was not associated with decreased odds of stroke (OR: 0.55 [0.28-1.17], p-value: 0.118).

Conclusions:

Aspirin use was associated with significantly decreased odds of incident ischemic stroke in adults with FMD, supporting consensus guidelines. Statin use was not associated with changes in stroke odds. Further investigation is underway, including adjudication of stroke outcomes and external validation within the North American Registry for FMD.