Migraine and cardiovascular disease: is there a link?

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Abstract

BACKGROUND

Migraine with aura (MA) has been linked to an increased risk of ischemic stroke. It is unclear whether MA is also associated with other vascular events, particularly coronary heart disease.

OBJECTIVE

To examine the association between migraine with or without aura and the risk of cardiovascular disease (CVD).

DESIGN AND INTERVENTION

During the period 1992-1995, 27,840 women aged 45 years or older who had no history of CVD were enrolled into this prospective cohort study conducted in the US. At baseline, 5,125 women reported a history of migraine, with 1,515 women reporting a past history of migraine, but no migraine attack during the past year, and 3,610 women reporting active migraine (defined as migraine in the year before baseline; 1,434 women had active MA and 2,176 women had active migraine without aura [MO]). The mean follow-up time was 10 years. Cox proportional hazards models were used to examine the association between migraine status and various outcome measures. In a multivariable model, the analysis was adjusted for factors that are known to have an impact on vascular risk, including age, systolic blood pressure, use of antihypertensive medication, diabetes, smoking, exercise and postmenopausal status.

OUTCOME MEASURES

The primary outcome variable was the composite end point of major CVD (defined as the first of any of the following events: nonfatal ischemic stroke, nonfatal myocardial infarction, or death resulting from ischemic CVD). Other outcome variables were first ischemic stroke, myocardial infarction, coronary revascularization, angina, and death resulting from ischemic CVD.

RESULTS

During follow-up, 580 major CVD events were observed. The incidence rates of all outcome events were higher in women with self-reported active MA than in women who had no history of migraine or in those who had active MO. Women with a past history of migraine had increased incidence rates for coronary revascularization and angina. After adjustment for multiple variables, and compared with women who had never had migraine, women with active MA had hazard ratios of 2.15 for major CVD (95% CI 1.58-2.92; P<0.001), 1.91 for ischemic stroke (95% CI 1.17-3.10; P=0.01), 2.08 for myocardial infarction (95% CI 1.30-3.31; P=0.002), 1.74 for coronary revascularization (95% CI 1.23-2.46; P=0.002), 1.71 for angina (95% CI 1.16-2.53; P=0.007) and 2.33 for ischemic CVD death (95% CI 1.21-4.51; P=0.01). By contrast, women with active MO did not have significantly increased risks for any of the outcome measures. Women with a past history of migraine had increased risks for coronary revascularization (hazard ratio 1.46, 95% CI 1.07-2.00; P=0.02) and angina (hazard ratio 1.66, 95% CI 1.19-2.32; P=0.003).

CONCLUSION

MA was associated with an increased risk of vascular events and angina, but MO was not.

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