Intended for healthcare professionals

CCBYNC Open access
Research

Migraine and risk of cardiovascular diseases: Danish population based matched cohort study

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k96 (Published 31 January 2018) Cite this as: BMJ 2018;360:k96
  1. Kasper Adelborg, postdoctoral fellow1,
  2. Szimonetta Komjáthiné Szépligeti, statistician1,
  3. Louise Holland-Bill, research fellow1,
  4. Vera Ehrenstein, professor1,
  5. Erzsébet Horváth-Puhó, statistician1,
  6. Victor W Henderson, professor1 2 3,
  7. Henrik Toft Sørensen, professor1 2
  1. 1Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
  2. 2Department of Health Research and Policy (Epidemiology), Stanford University, Stanford, CA, USA
  3. 3Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
  1. Correspondence to:
    K Adelborg kade{at}clin.au.dk
  • Accepted 12 December 2017

Abstract

Objective To examine the risks of myocardial infarction, stroke (ischaemic and haemorrhagic), peripheral artery disease, venous thromboembolism, atrial fibrillation or atrial flutter, and heart failure in patients with migraine and in a general population comparison cohort.

Design Nationwide, population based cohort study.

Setting All Danish hospitals and hospital outpatient clinics from 1995 to 2013.

Participants 51 032 patients with migraine and 510 320 people from the general population matched on age, sex, and calendar year.

Main outcome measures Comorbidity adjusted hazard ratios of cardiovascular outcomes based on Cox regression analysis.

Results Higher absolute risks were observed among patients with incident migraine than in the general population across most outcomes and follow-up periods. After 19 years of follow-up, the cumulative incidences per 1000 people for the migraine cohort compared with the general population were 25 v 17 for myocardial infarction, 45 v 25 for ischaemic stroke, 11 v 6 for haemorrhagic stroke, 13 v 11 for peripheral artery disease, 27 v 18 for venous thromboembolism, 47 v 34 for atrial fibrillation or atrial flutter, and 19 v 18 for heart failure. Correspondingly, migraine was positively associated with myocardial infarction (adjusted hazard ratio 1.49, 95% confidence interval 1.36 to 1.64), ischaemic stroke (2.26, 2.11 to 2.41), and haemorrhagic stroke (1.94, 1.68 to 2.23), as well as venous thromboembolism (1.59, 1.45 to 1.74) and atrial fibrillation or atrial flutter (1.25, 1.16 to 1.36). No meaningful association was found with peripheral artery disease (adjusted hazard ratio 1.12, 0.96 to 1.30) or heart failure (1.04, 0.93 to 1.16). The associations, particularly for stroke outcomes, were stronger during the short term (0-1 years) after diagnosis than the long term (up to 19 years), in patients with aura than in those without aura, and in women than in men. In a subcohort of patients, the associations persisted after additional multivariable adjustment for body mass index and smoking.

Conclusions Migraine was associated with increased risks of myocardial infarction, ischaemic stroke, haemorrhagic stroke, venous thromboembolism, and atrial fibrillation or atrial flutter. Migraine may be an important risk factor for most cardiovascular diseases.

Footnotes

  • Contributors: KA, SKS, LHB, VE, and HTS designed the study. EHP and HTS collected the data. KA reviewed the literature. KA, LHB, VWH, VE, EHP, and HTS directed the analyses, which were carried out by SKS. All authors participated in the discussion and interpretation of the results. KA organised the writing and wrote the initial draft. All authors critically revised the manuscript for intellectual content and approved the final version. HTS is the guarantor.

  • Funding: Aarhus University and the Program for Clinical Research Infrastructure (PROCRIN), established by the Lundbeck Foundation and the Novo Nordisk Foundation, funded the study. The sponsors had no role in study design, data collection, analysis or interpretation of the data, or writing of the manuscript or in the decision to submit the paper for publication. All authors had full access to the study data and had final responsibility for the decision to submit for publication.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work other than that detailed above; no financial relationships in the previous three years with any organisations that might have an interest in the submitted work; and no other relationships or activities that could appear to have influenced the submitted work.

  • Ethics approval: The study was approved by the Danish Data Protection Agency (record number 2006-53-1396). According to Danish legislation, informed consent or approval from an ethical committee is not required for registry based studies.

  • Data sharing: No additional data available.

  • Transparency: The senior author, HTS, affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

View Full Text