Increased risk for stroke in patients with familial Mediterranean fever: results from a large population-based study

Niv Ben-Shabat (Coresponding Author), Omer Gendelman, Lior Fisher, Uria Shani, Yonatan Shneor Patt, Abdulla Watad, Vita Skuja, Dennis McGonagle, Howard Amital

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: The association between chronic inflammatory conditions and cardiovascular disease is well established. Considering Familial-Mediterranean-Fever (FMF), few studies exist investigating the risk of ischemic heart disease, and none address the risk of stroke. We aimed to evaluate the incidence and risk for stroke in FMF patients compared to the general population.

METHODS: A retrospective cohort study using the electronic database of Clalit Health Services (CHS), the largest health organization in Israel. All FMF patients diagnosed between 2000-2016 were included and matched with control according to age, gender, and place of residence. Follow-up continued until the first diagnosis of stroke or death. The incidence of stroke was compared between the groups using univariate and multivariate models adjusting for cardiovascular risk-factors.

RESULTS: 9,769 FMF patients and a similar number of controls were followed up for a median period of 12.5 years. The mean age at the beginning of the follow-up was 25.7 years. 208 FMF patients were diagnosed with stroke compared to 148 controls, resulting in an incidence rate (per 10,000 persons-years) of 19.8 (95%CI 17.2-22.7), and 13.9 (95%CI 11.8 to 16.4) respectively, and a crude HR of 1.42 (95% CI 1.15 to 1.76; p < 0.001). In a multivariate analysis, FMF patients who developed amyloidosis with related or non-related renal failure demonstrated significant stroke risk (HR = 2.16; 95%CI 1.38 to 3.38; P < 0.001), as well as for those who did not develop these complications (HR = 1.32; 95%CI 1.04 to 1.67; P < 0.05).

CONCLUSION: FMF patients are at increased risk for stroke regardless of known complications.

Original languageEnglish
Number of pages7
Publication statusE-pub ahead of print - 2 Apr 2023


  • FMF
  • Atherosclerosis
  • Cardiovascular disease
  • Cerebrovascular event
  • Inflammation
  • Stroke

Field of Science*

  • 3.2 Clinical medicine

Publication Type*

  • 1.1. Scientific article indexed in Web of Science and/or Scopus database


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