Migraine and Persistent Vasomotor Symptoms Linked to Higher Risk of CVD, Stroke in Analysis of CARDIA Study

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A combined history of migraine and persistent vasomotor symptoms (VMS) was associated with increased risks for cardiovascular disease (CVD) and stroke, according to a recent analysis of women in the Coronary Artery Risk Development in Young Adults (CARDIA) study.¹

Findings published in the journal Menopause, showed that women with histories of migraine and persistent VMS had more than a 2-fold higher risk for CVD (HR 2.25; 95% CI, 1.15-4.38) compared with those without migraine and with minimal/increasing VMS, after adjusting for age, race, estrogen use, oophorectomy, and hysterectomy.¹

Also, women with both migraine and persistent VMS faced a more than 3-fold greater risk of stroke (HR 3.15; 95% CI, 1.35-7.34), reported first author Catherine Kim, MD, MPH, of the University of Michigan in Ann Arbor, and colleagues.¹

Previous research has shown that migraine, particularly with aura, and VMS are individual risk factors for CVD due to associated poorer CVD risk-factor profiles. The current study is the first to assess the joint influences of migraine and VMS independent of traditional CVD risk factors and estrogen use.

Kim and coauthors conducted the study to examine whether VMS (eg, hot flashes, night sweats) and migraines are associated with an increased risk for CVD events, including stroke. Researchers included 1954 women with 15-year follow-up data in the CARDIA study, which began data collection at 18 to 30 years of age and continued up to age 61, according to the study.¹

Specifically, investigators analyzed whether history of migraine and VMS trajectories (characterized as minimal, increasing, persistent) at CARDIA year 15 examination were jointly associated with higher risk of CVD events and stroke (both ischemic and hemorrhagic). They adjusted for reproductive factors and traditional CVD risk factors such as age, cigarette use, levels of systolic and diastolic blood pressure, fasting glucose, high- and low-density cholesterol, and triglycerides.¹

Among the 1954 women included in the study, 835 had minimal VMS, 521 had increasing VMS, and 598 had persistent VMS. Among them, there were 81 incident CVD events including 42 strokes, reported researchers.¹

As noted, investigators found that women with histories of migraine and persistent VMS had a risk of CVD 2 times greater than those without migraine history and with minimal/increasing VMS. After researchers adjusted for CVD risk factors, however, they noted these associations were attenuated (HR 1.51; 95% CI, 0.73-3.10).¹

In addition, the 3-fold increased risk of stroke observed among women with histories of migraine and persistent VMS was also attenuated after adjustment for CVD risk factors (HR 1.70; 95% CI, 0.66-4.38), according to Kim and colleagues.¹

“This study highlights the importance of considering female-predominant or female-specific factors such as history of migraine and persistent vasomotor symptoms when assessing cardiovascular risk in women,” said Stephanie Faubion, MD, MBA, medical director for The Menopause Society, who was not part of the research team, in a press release. “There is a critical need to further refine existing cardiovascular disease risk-prediction models to identify women more accurately at future risk. In the interim, risk factor optimization is important for women with both of these conditions.”²

References:

• Kim C, Schreiner P, Yin Z, et al. Migraines, vasomotor symptoms, and cardiovascular disease in the Coronary Artery Risk Development in Young Adults study. Menopause. 2024;31:202-208. doi:10.1097/GME.0000000000002311
• The combination of migraine and persistent hot flashes could prove deadly. News release. The Menopause Society. Published February 14, 2024. Accessed March 1, 2024. https://www.menopause.org/docs/default-source/press-release/migraines-vms-and-cvd-risk.pdf