https://immattersacp.org/weekly/archives/2018/02/06/4.htm

Migraine associated with cardiovascular risks

Higher absolute risks of cardiovascular disease were observed among patients with migraine across most outcomes and follow-up periods during 19 years of follow-up.


Migraine was associated with increased risks of myocardial infarction, ischemic stroke, hemorrhagic stroke, venous thromboembolism, and atrial fibrillation or atrial flutter in a recent study.

To examine the cardiovascular risks of patients with migraine compared to the general population, Danish researchers conducted a nationwide cohort study in hospitals and hospital outpatient clinics from 1995 to 2013. Overall, 51,032 patients with migraine and 510,320 people from the general population were matched 1:10 on age, sex, and calendar year. Study results were published Jan. 31 by The BMJ.

Higher absolute risks were observed among patients with migraine across most outcomes and follow-up periods. After 19 years of follow-up, the cumulative incidences per 1,000 people for the migraine cohort compared with the general population were:

  • 25 vs. 17 for myocardial infarction,
  • 45 vs. 25 for ischemic stroke,
  • 11 vs. 6 for hemorrhagic stroke,
  • 13 vs. 11 for peripheral artery disease,
  • 27 vs. 18 for venous thromboembolism,
  • 47 vs. 34 for atrial fibrillation or atrial flutter, and
  • 19 vs. 18 for heart failure.

The adjusted hazard ratios (HRs) for patients with migraine were 1.49 (95% CI, 1.36 to 1.64) for myocardial infarction, 2.26 (95% CI, 2.11 to 2.41) for ischemic stroke, 1.94 (95% CI, 1.68 to 2.23) for hemorrhagic stroke, 1.59 (95% CI, 1.45 to 1.74) for venous thromboembolism, and 1.25 (95% CI, 1.16 to 1.36) for atrial fibrillation or atrial flutter. No significant association was seen between migraine and peripheral artery disease (HR, 1.12; 95% CI, 0.96 to 1.30) or heart failure (HR, 1.04; 95% CI, 0.93 to 1.16).

Associations, particularly for stroke outcomes, were stronger in patients less than a year after migraine diagnosis than up to 19 years after. They were also stronger in patients with aura than in those without aura and in women than in men. Associations persisted in a subcohort after adjustment for body mass index and smoking.

Migraine may be an important risk factor for most cardiovascular diseases, the researchers concluded, while acknowledging that the absolute risks for cardiovascular outcomes were low, given the young age of the study population. “Although the magnitude of the increased cardiovascular risk associated with migraine was fairly small at the individual level, it translates into a substantial increase in risk at the population level, because migraine is a common disease,” the authors wrote.

An editorial called for more research into the association. “Now, the accumulated evidence leads clinicians to warn patients (correctly) that migraine puts them at a heightened risk for cardiovascular events. Simply advising this patient population to reduce other vascular risk factors seems like a shot in the dark,” the editorial stated. “In adults with hypertension, prescribed antihypertensives and lifestyle changes are effective in lowering cardiovascular risk. Could people with migraine experience a similar reduction in cardiovascular risk if the frequency or severity of migraine is reduced? We simply do not know.”