Introduction: Idiopathic intracranial hypertension (IIH) has been traditionally viewed as a neuro-ophthalmic disorder, yet emerging evidence suggests broader systemic implications. Our study investigates the cardiometabolic outcomes associated with IIH through a comprehensive matched-cohort analysis. Methods: We conducted a retrospective analysis of electronic health records from 2009 to 2024. We compared IIH patients with matched controls using propensity score matching based on age, sex, race, ethnicity, and baseline BMI. Cardiovascular and metabolic outcomes were assessed over a ten-year follow-up period, with additional stratified analyses comparing obese and non-obese subgroups. Results: IIH patients demonstrated significantly increased risks of ischemic stroke/TIA (RR 2.515, 95% CI 2.250-2.812) and non-traumatic hemorrhagic stroke (RR 7.744, 95% CI 6.118-9.801). Notable metabolic findings included elevated risks of insulin resistance (RR 1.470, 95% CI 1.258-1.717) and type 2 diabetes mellitus (RR 1.210, 95% CI 1.171-1.250). These associations persisted in non-obese IIH patients, suggesting pathogenic mechanisms independent of adiposity. Additionally, IIH patients showed increased prevalence of polycystic ovarian syndrome (RR 1.470, 95% CI 1.258-1.717) and metabolic syndrome (RR 1.125, 95% CI 1.045-1.205). Conclusions: Our findings highlight IIH as a complex multisystem disorder with significant cardiometabolic implications beyond its traditional neuro-ophthalmic presentation. The findings suggest the need for comprehensive cardiovascular and metabolic screening in IIH patients, regardless of BMI status, and indicate potential novel therapeutic targets for investigation.

The project described was supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through CTSA award number: UM1TR004400. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

The project described was supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through CTSA award number: UM1TR004400. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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