Next Gen Innovators

Next Gen Innovators

February 06, 2018
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Migraines increase risk for CVD

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Patients with migraine had an increased risk for ischemic stroke, hemorrhagic stroke, MI, venous thromboembolism, and atrial fibrillation or atrial flutter, according to a study published in The BMJ.

Kasper Adelborg, MD, postdoctoral fellow in the department of clinical epidemiology at Aarhus University Hospital in Denmark, and colleagues analyzed data from 51,032 patients (median age, 35 years; 29% men) with a first time primary or secondary diagnosis of migraine from the Danish National Patient Registry from January 1995 to November 2013. Patients who were diagnosed with migraine before 1995 or had a history of stroke, MI, peripheral artery disease, AF or atrial flutter, VTE or HF were excluded from the study.

Matched cohorts

Each patient with migraine was matched with 10 patients free from migraine (n = 510,320). The same exclusion criteria were used for this cohort.

The incident outcomes of interest were PAD, MI, hemorrhagic or ischemic stroke, AF or atrial flutter, VTE and HF.

At the index date, patients with migraine had a slightly higher burden of comorbidity and CV risk factors compared with those without migraine.

After 19 years of follow-up, cumulative incidences per 1,000 patients for the migraine cohort compared with the general population was 45 vs. 25 for ischemic stroke, 25 vs. 17 for MI, 13 vs. 11 for PAD, 11 vs. 6 for hemorrhagic stroke, 27 vs. 18 for VTE, 19 vs. 18 for HF and 47 vs. 34 for AF or atrial flutter, respectively.

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After adjusting for covariables, migraine was linked to ischemic stroke (adjusted HR = 2.26; 95% CI, 2.11-2.41), MI (aHR = 1.49; 95% CI, 1.36-1.64), hemorrhagic stroke (aHR = 1.94; 95% CI, 1.68-2.23), AF or atrial flutter (aHR = 1.25; 95% CI, 1.16-1.36) and VTE (aHR = 1.59; 95% CI, 1.45-1.74).

Migraine was not associated with HF (adjusted HR = 1.04; 95% CI, 0.93-1.16) or PAD (adjusted HR = 1.12; 95% CI, 0.96-1.3).

Increased risk at 1 year

The risk for CVD was higher in patients during the first year after a migraine diagnosis. CVD risk was also increased in women and patients who had migraines with aura.

“Current migraine guidelines do not recommend use of aspirin and clopidogrel in the prophylaxis of migraine, but clinicians should consider whether patients at particularly high risk of cardiovascular diseases would benefit from anticoagulant treatment,” Adelborg and colleagues wrote. “Ultimately, 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.”

In a related editorial, Tobias Kurth, MD, professor at the Institute of Public Health at Charité–Universitätsmedizin Berlin, and colleagues wrote: “We now have plenty of evidence that migraine should be taken seriously as a strong cardiovascular risk marker. However, whether migraine itself is the problem or whether the disease is a marker of another underlying cause remains unclear. From the patient’s perspective, this knowledge, coupled with a lack of evidence on any possible solutions to lower cardiovascular risk, contributes to feelings of anxiety, helplessness and frustration.” – by Darlene Dobkowski

Disclosures: Adelborg reports no relevant financial disclosures. Kurth reports he has provided methodological expertise to Amgen and CoLucid and received honorarium from Novartis.