Migraine, vascular risk, and cardiovascular events in women: prospective cohort studyBMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a636 (Published 07 August 2008) Cite this as: BMJ 2008;337:a636
- Tobias Kurth, assistant professor of medicine123,
- Markus Schürks, research fellow in medicine1,
- Giancarlo Logroscino, associate professor of neurology4,
- J Michael Gaziano, associate professor of medicine125,
- Julie E Buring, professor of medicine1236
- 1Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- 2Division of Aging, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- 3Department of Epidemiology, Harvard School of Public Health, Boston, MA
- 4Department of Neurology and Psychiatry, School of Medicine, University of Bari, Italy
- 5Massachusetts Veterans Epidemiology Research and Information Center, Boston VA Healthcare System, Boston, MA
- 6Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, MA
- Correspondence to: T Kurth
- Accepted 27 May 2008
Objectives To evaluate whether the association between migraine with aura and increased risk of cardiovascular disease is modified by vascular risk groups as measured by the Framingham risk score for coronary heart disease.
Design Prospective cohort study.
Setting Women’s health study, United States.
Participants 27 519 women who were free from cardiovascular disease at baseline with available information on the Framingham risk 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 11.9 years of follow-up, there were 697 cardiovascular disease events. We stratified participants based on 10 year risk of coronary heart 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 migraine with aura were 1.93 (95% confidence interval 1.45 to 2.56) for major cardiovascular disease, 1.80 (1.16 to 2.79) for ischaemic stroke, and 1.94 (1.27 to 2.95) for myocardial infarction. When stratified by Framingham risk score, the association between migraine with aura and major cardiovascular disease was strongest in the lowest risk score group. There was a diametric association pattern for ischaemic stroke and myocardial infarction. Compared with women without migraine, the age adjusted hazard ratios in women who reported migraine with aura in the lowest Framingham risk score group were 3.88 (1.87 to 8.08) for ischaemic stroke and 1.29 (0.40 to 4.21) for myocardial infarction. Hazard ratios in women with migraine with aura in the highest Framingham risk score group were 1.00 (0.24 to 4.14) for ischaemic stroke and 3.34 (1.50 to 7.46) for myocardial infarction. Women with migraine without aura were not at increased risk of ischaemic stroke or myocardial infarction in any of the Framingham risk score groups.
Conclusion The association between migraine with aura and cardiovascular disease varies by vascular risk status. Information on history of migraine and vascular risk status might help to identify women at increased risk for specific future cardiovascular disease events.
Trial registration Clinical trials NCT00000479.
We thank the participants in the women’s health study for their outstanding commitment and cooperation and all the staff for their expert and unfailing assistance.
Contributors: TK conceived and designed the study, analysed the data, and drafted the manuscript. JEB was responsible for the acquisition of the data. All authors interpreted the data, critically revised the draft for important intellectual content, and gave final approval of the version to be published. TK is guarantor.
Funding: The women’s health study is supported by grants and from the National Heart, Lung, and Blood Institute (HL-043851 and HL-080467), and the National Cancer Institute (CA-47988). The research for this work was supported by grants from the Donald W Reynolds Foundation, the Leducq Foundation, and the Doris Duke Charitable Foundation.
Competing interests: TK has received funding from the National Institutes of Health, Bayer AG, McNeil Consumer and Specialty Pharmaceuticals, and Wyeth Consumer Healthcare; he is a consultant to i3 Drug Safety, and received an honorarium from Organon for contributing to an expert panel. MS has received funding from the Deutsche Forschungsgemeinschaft and an unrestricted research grant from Merck, Sharp and Dohme. GL has received funding from the National Institutes of Health and received honoraria from Pfizer and Lilly Pharmaceutical for speaking engagements in 2003. JMG has received funding and support from National Institutes of Health, BASF, DSM Pharmaceuticals, Wyeth Pharmaceuticals, McNeil Consumer Products and Pliva; received honoraria from Bayer and Pfizer for speaking engagements, and is a consultant for Bayer, McNeil Consumer Products, Wyeth Pharmaceuticals, Merck, Nutraquest, and GlaxoSmithKline. JEB has received funding and support from the National Institutes of Health and Dow Corning Corporation; research support from Bayer Heath Care and the Natural Source Vitamin E Association; and an honoraria from Bayer for speaking engagements.
Ethical approval: Institutional review board of Brigham and Women’s Hospital, Boston, MA USA.
Provenance and peer review: Not commissioned; externally peer reviewed.
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