Cardiovascular Risk Increased in Patients With Migraine

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The association between migraine and stroke was the strongest within 1 year after a diagnosis of migraine with aura and in women.
The association between migraine and stroke was the strongest within 1 year after a diagnosis of migraine with aura and in women.

People with migraine are at increased risk for cardiovascular disease, including myocardial infarction (MI), ischemic stroke, hemorrhagic stroke, venous thromboembolism (VTE), and atrial fibrillation (AF)/atrial flutter compared with people without migraine, according to a study published in BMJ.

A team of Danish investigators used a population database spanning a 19-year period and compared data from patients with migraine with those of controls matched by age, sex, and calendar year (n=51,032 and 510,320 respectively). The median age at diagnosis of those with migraine was 35 years (range 22-47 years), and women constituted 71% of the study population.

The investigators examined an array of cardiovascular conditions, including MI and ischemic and hemorrhagic stroke, peripheral artery disease (PAD), VTE, heart failure (HF), and AF/atrial flutter in patients with a first-time migraine diagnosis.

They found that the first year after migraine diagnosis was associated with the greatest increased risk (8-fold increased risk for stroke and a roughly 2-fold increased risk for MI, VTE, and AF/atrial flutter) vs the risk found in the general population.

When the researchers examined 19-year follow-up data, they found higher cumulative incidences of cardiovascular conditions (per 1000) in those with migraine than in the general population (MI, 25 vs 17; ischemic stroke, 45 vs 25; hemorrhagic stroke, 11 vs 6; PAD, 13 vs 11; VTE, 27 vs 18; AF/atrial flutter, 47 vs 34; HF, 19 vs 18).

Migraine also remained associated with MI, ischemic stroke, hemorrhagic stroke, VTE, and AF/atrial flutter even after adjusting for covariables. However, the researchers found no association between migraine and PAD or HF.

The associations were stronger in patients whose migraines were accompanied by aura vs those without aura and were also stronger in females than in males.

“In this nationwide cohort study, migraine was associated with an increased risk of cardiovascular disease. This suggests that migraine should be considered a potent and persistent risk factor for most cardiovascular diseases in both men and women,” the investigators concluded.

“Ultimately,” they added, “it will be important to determine whether prevention strategies in patients with migraine can reduce the burden of cardiovascular disease in patients with this common disorder.”

Reference

Adelborg K, Szépligeti SK, Holland-Bill L, et al. Migraine and risk of cardiovascular diseases: Danish population based matched cohort study. BMJ. 2018;360:k96.

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