Migraine, vascular risk, and cardiovascular events in women: prospective cohort study

doi:10.1136/bmj.a636

Published 7 August 2008, doi:10.1136/bmj.a636
Cite this as: BMJ 2008;337:a636

Research

Migraine, vascular risk, and cardiovascular events in women: prospective cohort study

Tobias Kurth, assistant professor of medicine¹^,2^,3, Markus Schürks, research fellow in medicine¹, Giancarlo Logroscino, associate professor of neurology⁴, J Michael Gaziano, associate professor of medicine¹^,2^,5, Julie E Buring, professor of medicine¹^,2^,3^,6

¹ Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA, ² Division of Aging, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, ³ Department of Epidemiology, Harvard School of Public Health, Boston, MA, ⁴ Department of Neurology and Psychiatry, School of Medicine, University of Bari, Italy, ⁵ Massachusetts Veterans Epidemiology Research and Information Center, Boston VA Healthcare System, Boston, MA, ⁶ Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, MA

Correspondence to: T Kurth tkurth{at}rics.bwh.harvard.edu

Objectives To evaluate whether the association between migrainewith aura and increased risk of cardiovascular disease is modifiedby vascular risk groups as measured by the Framingham risk scorefor coronary heart disease.

Design Prospective cohort study.

Setting Women’s health study, United States.

Participants 27 519 women who were free from cardiovasculardisease at baseline with available information on the Framinghamrisk score and migraine status.

Main outcome measures Time to major cardiovascular disease event(non-fatal myocardial infarction, non-fatal ischaemic stroke,death from ischaemic cardiovascular disease), myocardial infarction,and ischaemic stroke.

Results At baseline, 3577 (13.0%) women reported active migraine,of whom 1418 (39.6%) reported migraine with aura. During 11.9years of follow-up, there were 697 cardiovascular disease events.We stratified participants based on 10 year risk of coronaryheart disease estimated from the Framingham risk score ( $≤$ 1%,2-4%, 5-9%, and $≥$ 10%). Compared with women without migraine,the age adjusted hazard ratios in women with active migrainewith aura were 1.93 (95% confidence interval 1.45 to 2.56) formajor cardiovascular disease, 1.80 (1.16 to 2.79) for ischaemicstroke, and 1.94 (1.27 to 2.95) for myocardial infarction. Whenstratified by Framingham risk score, the association betweenmigraine with aura and major cardiovascular disease was strongestin the lowest risk score group. There was a diametric associationpattern for ischaemic stroke and myocardial infarction. Comparedwith women without migraine, the age adjusted hazard ratiosin women who reported migraine with aura in the lowest Framinghamrisk score group were 3.88 (1.87 to 8.08) for ischaemic strokeand 1.29 (0.40 to 4.21) for myocardial infarction. Hazard ratiosin women with migraine with aura in the highest Framingham riskscore group were 1.00 (0.24 to 4.14) for ischaemic stroke and3.34 (1.50 to 7.46) for myocardial infarction. Women with migrainewithout aura were not at increased risk of ischaemic strokeor myocardial infarction in any of the Framingham risk scoregroups.

Conclusion The association between migraine with aura and cardiovasculardisease varies by vascular risk status. Information on historyof migraine and vascular risk status might help to identifywomen at increased risk for specific future cardiovascular diseaseevents.

Trial registration Clinical trials NCT00000479 [ClinicalTrials.gov] .

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