Migraine associated with increased risk of cardiovascular events

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Migraines are linked to cardiovascular events, including myocardial infarction, VTE, and stroke.
Migraines are linked to cardiovascular events, including myocardial infarction, VTE, and stroke.

Migraines are associated with elevated risks in several cardiovascular comorbidities, including myocardial infarction, stroke, and venous thromboembolism (VTE), according to a study published in the BMJ.

Kasper Adelborg, MD, PhD, a postdoctoral fellow at the Department of Clinical Epidemiology at Aarhus University Hospital in Denmark, and associates conducted a nationwide, population-based matched group analysis to assess the cardiovascular risks associated with migraines in the general population.

The study involved 51,032 patients (71% women) who reported a primary or secondary migraine and 510,032 individuals matched with age and gender for the control cohort. The cohort was monitored from 1995 to 2013. The median age at reported migraine was 35.

Myocardial infarction, peripheral artery disease, VTE, atrial fibrillation, heart failure, and ischemic and hemorrhagic strokes were all comorbidities measured as main outcomes. Of the migraine group, 2451 individuals had a cardiovascular episode, while 575 individuals experienced more than one cardiovascular event.

Statistical analysis revealed a correlation between migraines and myocardial infarctions, ischemic stroke, and hemorrhagic stroke (adjusted hazard ratio [HR]: 1.49; 2.26; 1.94, respectively). Stroke was more prevalent in the first 0 to 1 years after initial diagnosis than in the long term (≤19 years) after diagnosis. Stroke was also more prevalent in patients who experienced migraine with aura than in those who had migraine without aura and was more common in women than in men, though persistent in both sexes.

Additionally, migraines were also correlated with VTE (HR, 1.59) and atrial fibrillation (HR, 1.25). In contrast, the investigators did not find any affiliations between migraines and peripheral artery disease or heart failure.

“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 reported.

“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,” the authors continued. “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.”

Reference

  1. Adelborg K, Szépligeti SK, Holland-Bill L, et al. Migraine and risk of cardiovascular diseases: Danish population based matched cohort study. BMJ. 2018 Jan 31. doi: 10.1136/bmj.k96
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