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Is there an association between migraine with aura and cardiovascular disease (CVD) incidence rates in women, relative to that of other major vascular risk factors?
In this cohort study that included 27 858 female health professionals aged at least 45 years, the adjusted incidence rate of major CVD was 3.36 per 1000 person-years for women who reported migraine with aura and 2.11 per 1000 person-years for women who reported migraine without aura or no migraine, a difference that was statistically significant.
Among female health professionals aged at least 45 years, self-reported migraine with aura was associated with increased incidence rates of CVD, but the clinical importance of this finding remains to be determined.
Migraine with aura is known to increase the risk of cardiovascular disease (CVD). The absolute contribution of migraine with aura to CVD incidence in relation to other CVD risk factors remains unclear.
To estimate the CVD incidence rate for women with migraine with aura relative to women with other major vascular risk factors.
Design, Setting, and Participants
Female health professionals in the US (the Women’s Health Study cohort) with lipid measurements and no CVD at baseline (1992-1995) were followed up through December 31, 2018.
Self-reported migraine with aura compared with migraine without aura or no migraine at baseline.
Main Outcomes and Measures
The primary outcome was major CVD (first myocardial infarction, stroke, or CVD death). Generalized modeling procedures were used to calculate multivariable-adjusted incidence rates for major CVD events by risk factor status that included all women in the cohort.
The study population included 27 858 women (mean [SD] age at baseline, 54.7 [7.1] years), among whom 1435 (5.2%) had migraine with aura and 26 423 (94.8%) did not (2177 [7.8%] had migraine without aura and 24 246 [87.0%] had no migraine in the year prior to baseline). During a mean follow-up of 22.6 years (629 353 person-years), 1666 major CVD events occurred. The adjusted incidence rate of major CVD per 1000 person-years was 3.36 (95% CI, 2.72-3.99) for women with migraine with aura vs 2.11 (95% CI, 1.98-2.24) for women with migraine without aura or no migraine (P < .001). The incidence rate for women with migraine with aura was significantly higher than the adjusted incidence rate among women with obesity (2.29 [95% CI, 2.02-2.56]), high triglycerides (2.67 [95% CI, 2.38-2.95]), or low high-density lipoprotein cholesterol (2.63 [95% CI, 2.33-2.94]), but was not significantly different from the rates among those with elevated systolic blood pressure (3.78 [95% CI, 2.76-4.81]), high total cholesterol (2.85 [95% CI, 2.38-3.32]), or family history of myocardial infarction (2.71 [95% CI, 2.38-3.05]). Incidence rates among women with diabetes (5.76 [95% CI, 4.68-6.84]) or who currently smoked (4.29 [95% CI, 3.79-4.79]) were significantly higher than those with migraine with aura. The incremental increase in the incidence rate for migraine with aura ranged from 1.01 additional cases per 1000 person-years when added to obesity to 2.57 additional cases per 1000 person-years when added to diabetes.
Conclusions and Relevance
In this study of female health professionals aged at least 45 years, women with migraine with aura had a higher adjusted incidence rate of CVD compared with women with migraine without aura or no migraine. The clinical importance of these findings, and whether they are generalizable beyond this study population, require further research.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Tobias Kurth, MD, ScD, Institute of Public Health, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany (email@example.com).
Accepted for Publication: April 18, 2020.
Author Contributions: Drs Kurth and Bubes had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Kurth.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Kurth, Kotler, Bubes.
Critical revision of the manuscript for important intellectual content: Kurth, Rist, Ridker, Bubes, Buring.
Statistical analysis: Kurth, Kotler, Bubes.
Administrative, technical, or material support: Ridker, Bubes.
Supervision: Kurth, Ridker.
Conflict of Interest Disclosures: Dr Kurth reported receiving personal fees from Eli Lilly, Newsenselab, CoLucid, Total, Novartis, and Daiichi Sankyo and grants from Amgen during the conduct of the study and personal fees from BMJ outside the submitted work. Dr Rist reported receiving grants from the National Heart, Lung, and Blood Institute, Brigham and Women's Hospital, and Biogen during the conduct of the study and personal fees from the American Heart Association outside the submitted work. Dr Ridker reported receiving grants from Novartis and Kowa and personal fees from Inflazome, Corvidia, Johnson & Johnson, and Amarin outside the submitted work. Dr Buring reported receiving grants from the National Institutes of Health during the conduct of the study. No other disclosures were reported.
Funding/Support: The Women’s Health Study is funded by grants from the National Cancer Institute (CA047988 and UM1 CA182913) and the National Heart, Lung, and Blood Institute (HL043851, HL080467, and HL099355). Dr Rist is supported by a Career Development Award from the National Heart, Lung, and Blood Institute (K01 HL128791).
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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