Cardiovascular risk factors and BPPV: an exploratory case-control analysis
DOI:
https://doi.org/10.34631/sporl.3200Keywords:
Benign paroxysmal positional vertigo, Cardiovascular risk factors, Diabetes Mellitus, Type 2, DizzinessAbstract
Introduction: Some cardiovascular risk factors have been associated with benign paroxysmal positional vertigo (BPPV), under the hypothesis that they potentiate utricular degeneration; however, the evidence supporting this remains controversial.
Objectives: To evaluate the prevalence of cardiovascular risk factors (CVRF) and their potential impact on the occurrence of BPPV and its variants.
Material and methods: The study included 37 patients consecutively diagnosed with BPPV and 37 age-matched controls. The cases had a mean age of 64,1 ± 11,7 years and included 30 women and 7 men. The relationship between CVRF—including arterial hypertension (HTN), diabetes mellitus (DM), dyslipidemia (DLP), cardiovascular and cerebrovascular disease (CCVD)—and BPPV was evaluated through univariate and multivariate analysis.
Results: A higher prevalence of DM was identified in patients compared to controls (p < 0.05), as well as a higher simultaneous presence of all three CVRF in individuals with BPPV (p < 0.05). On the other hand, the presence of CVRF did not influence the duration or recurrence of BPPV episodes, nor the affected semicircular canal. The presence of DM was associated with a significantly elevated risk of BPPV (adjusted odds ratio of 9.3; 95% CI 1.5–56.4).
Conclusion: BPPV may be associated with an increased vascular risk in some patients, especially those with diabetes and multiple simultaneous CVRF. Confirmation of this evidence in studies with a larger number of subjects could reinforce early diagnostic measures in at-risk patients. However, most cases of BPPV appear to be idiopathic or caused by other factors not yet confirmed.
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References
1. Imai T, Inohara H. Benign paroxysmal positional vertigo. Auris Nasus Larynx. 2022 Oct;49(5):737-747. doi: 10.1016/j.anl.2022.03.012.
2. Kao WTK, Parnes LS, Chole RA. Otoconia and otolithic membrane fragments within the posterior semicircular canal in benign paroxysmal positional vertigo. Laryngoscope. 2017 Mar;127(3):709-714. doi: 10.1002/lary.26115.
3. Von Brevern M, Bertholon P, Brandt T, Fife T, Imai T, Nuti D. et al. Benign paroxysmal positional vertigo: diagnostic criteria. J Vestib Res. 2015;25(3-4):105-17. doi: 10.3233/VES-150553.
4. Von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T. et al. Epidemiology of benign paroxysmal positional vertigo: A population based study. J Neurol Neurosurg Psychiatry. 2007 Jul;78(7):710-5. doi: 10.1136/jnnp.2006.100420.
5. Alolayet H, Murdin L. Benign paroxysmal positional vertigo a systematic review of the effects of comorbidities. Front Neurol. 2025 May 23:16:1595693. doi: 10.3389/fneur.2025.1595693.
6. Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T. et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngol Head Neck Surg. 2017 Mar;156(3_suppl):S1-S47. doi: 10.1177/0194599816689667.
7. Pan Q, Li B, Zou K, Zhang J, Wang Y, Tang X. Risk factors and a nomogram model for recurrence of benign paroxysmal positional vertigo: a multicenter cross-sectional study. Front Neurol. 2025 Apr 3:16:1542090. doi: 10.3389/fneur.2025.1542090.
8. Singh JM, Corser WD, Monsell EM. Cardiovascular risk factors and benign paroxysmal positional vertigo in community otolaryngology–head and neck surgery. Otolaryngol Head Neck Surg. 2020 Mar;162(3):283-289. doi: 10.1177/0194599820902116.
9. Sfakianaki I, Binos P, Karkos P, Dimas GG, Psillas G. Risk factors for recurrence of benign paroxysmal positional vertigo. A clinical review. J Clin Med. 2021 Sep 24;10(19):4372. doi: 10.3390/jcm10194372.
10. Chen J, Zhang S, Cui K, Liu C. Risk factors for benign paroxysmal positional vertigo recurrence: a systematic review and meta-analysis. J Neurol. 2021 Nov;268(11):4117-4127. doi: 10.1007/s00415-020-10175-0.
11. Elnasieh A, Alturki A, Al-Hazm AN, Alhadlaq R, Howaidi NB, Elnasieh MA. Prevalence of symptoms suggestive of benign paroxysmal positional vertigo and associated factors among adults attending King Saud Medical City in Riyadh. Cureus. 2025 Jul 15;17(7):e87976. doi: 10.7759/cureus.87976.
12. Malay S, Chung KC. The choice of controls for providing validity and evidence in clinical research. Plast Reconstr Surg. 2012 Oct;130(4):959-965. doi: 10.1097/PRS.0b013e318262f4c8.
13. Li L, Zhang M, Holman D. Population versus hospital controls for case-control studies on cancers in Chinese hospitals. BMC Med Res Methodol. 2011 Dec 15:11:167. doi: 10.1186/1471-2288-11-167.
14. Lin HC, Chao PZ, Lee HC. Sudden sensorineural hearing loss increases the risk of stroke: a 5-year follow-up study. Stroke. 2008 Oct;39(10):2744-8. doi: 10.1161/STROKEAHA.108.519090.
15. Simões JFCPM, Vlaminck S, Seiça R, Acke F, Miguéis A. Cardiovascular risk factors among patients with acute unilateral inner ear hypofunction: a case–control study. Laryngoscope Investig Otolaryngol. 2022 Dec 12;8(1):245-252. doi: 10.1002/lio2.992.
16. Wen Y, Fan Y, Jian B. Identifying key risk factors for the recurrence of benign paroxysmal positional vertigo following successful canalith repositioning maneuvers: a meta analysis. Eur J Med Res. 2025 Apr 10;30(1):262. doi: 10.1186/s40001-025-02482-x.
17. Picciotti PM, Lucidi D, De Corso E, Meucci D, Sergi B, Paludetti G. Comorbidities and recurrence of benign paroxysmal positional vertigo: personal experience. Int J Audiol. 2016;55(5):279-84. doi: 10.3109/14992027.2016.1143981.
18. Kumar P, Singh NK, Raveendran RK, Apeksha K, Ghosh V, Bhanukumar M. The functioning of otolith organs in individuals with type-II diabetes mellitus. Hear Res. 2025 Nov:467:109412. doi: 10.1016/j.heares.2025.109412.
19. Konukseven O, Polat SB, Karahan S, Konukseven E, Ersoy R, Cakir B. et al. Electrophysiologic vestibular evaluation in type 2 diabetic and prediabetic patients: air conduction ocular and cervical vestibular evoked myogenic potentials. Int J Audiol. 2015 Aug;54(8):536-43. doi: 10.3109/14992027.2014.971887.
20. Cao W, Geng Y, Chang J, Li F. Risk factors for benign paroxysmal positional vertigo and construction of a nomogram predictive model. Am J Transl Res. 2024 Jun 15;16(6):2435-2444. doi: 10.62347/DHAJ4799.
21. Zang J, Jiang X, Feng S, Zhang H. The influence of cerebral small vessel diseases on the efficacy of repositioning therapy and prognosis of benign paroxysmal positional vertigo. Int J Med Sci. 2022 Jul 4;19(8):1227-1234. doi: 10.7150/ijms.73080.
22. Comacchio F, Biancoli E, Poletto E, Bellemo B, Magnavita P. Acute bilateral vestibular neuropathy during myocardial infarction: A Case Report. J. Otorhinolaryngol. Hear. Balance Med. 2025 Sep 12;6(2):15. doi:10.3390/ohbm6020015.
23. Doğan B, Baklacı D. Association between diabetes mellitus, hypertension, migraine, and recurrence risk in benign paroxysmal positional vertigo: a retrospective cohort study. Front Neurol. 2026 Feb 24:17:1785013. doi: 10.3389/fneur.2026.1785013.
24. Swarup S, Ahmed I, Grigorova Y, Zeltser R. Metabolic Syndrome. [Updated 2024 Mar 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459248/
25. Xing J, Yang P, Ren R, Zhao C, Cheng Z, Yang Y. et al. [Effect of body mass index on efficacy of the repositioning procedure for horizontal canal benign paroxysmal positional vertigo]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Nov;36(11):869-871;874. doi: 10.13201/j.issn.2096-7993.2022.11.012.
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Copyright (c) 2026 Miguel Serra, João Simões, Diana Ribeiro, César Anjo, Ilídio Gonçalves, Luis Freitas
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