Migraine with Aura Linked to Increased CVD in Women

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Among women aged at least 45 years, migraine with aura was associated with significantly increased incidence of cardiovascular disease (CVD) vs women with migraine without aura or without migraine, according to a study published online in the Journal of the American Medical Association.

CVD incidence among women with migraine with aura also was greater than adjusted rates among women with several other major CVD risk factors

The study followed 27 858 women from the Women’s Health Study with lipid measurements and no CVD at baseline (1992-1995) through December 31, 2018. Mean age at baseline was 54.7 years. In the cohort, 5.2% self-reported migraine with aura, 7.8% reported migraine without aura, and 87.0% did not experience migraine in the year prior to baseline.

The primary outcome was major CVD (first myocardial infarction [MI], 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.

During mean follow-up of 22 years, 1666 major CVD events, 887 strokes (fatal and nonfatal), 629 myocardial infarctions (fatal and nonfatal), and 391 deaths due to CVD took place.

Adjusted incidence rates for major CVD events per 1000 per-years:

• 3.36 (95% CI, 2.72-3.99) for women with migraine with aura
• 2.11 (95% CI, 1.98-2.24) for migraine without aura or no migraine (P< .001)
• 2.29 for women with obesity (95% CI, 2.02-2.56)
• 2.67 for high triglycerides (95% CI, 2.38-2.95)
• 2.63 for women with low HDL-C (95% CI, 2.33-2.94)

Incidence of CVD in women with migraine with aura did not differ significantly from rates among those with elevated systolic blood pressure , high total cholesterol, or family history of myocardial infarction.

The 2 risk factors associated with CVD incidence rates higher than migraineurs with aura were diabetes (5.76) and current smoking (4.29)

Researchers, led by Tobias Kurth, MD, adjust professor of epidemiology at Harvard’s TH Chan School of Public Health, also found that “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.”

Due to the use of self-report for migraine status and CVD risk factors, misclassification may have occurred; the study did not account for changes in risk factors over time nor was information available on treatment. The authors note that the clinical importance of the findings and whether they can be generalized beyond the current population require further research.