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Migraine, vascular risk, and cardiovascular events in women: prospective cohort study.
BMJ 2008; 337:a636BMJ

Abstract

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 (<or=1%, 2-4%, 5-9%, and >or=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.

Authors+Show Affiliations

Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. tkurth@rics.bwh.harvard.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18687721

Citation

Kurth, Tobias, et al. "Migraine, Vascular Risk, and Cardiovascular Events in Women: Prospective Cohort Study." BMJ (Clinical Research Ed.), vol. 337, 2008, pp. a636.
Kurth T, Schürks M, Logroscino G, et al. Migraine, vascular risk, and cardiovascular events in women: prospective cohort study. BMJ. 2008;337:a636.
Kurth, T., Schürks, M., Logroscino, G., Gaziano, J. M., & Buring, J. E. (2008). Migraine, vascular risk, and cardiovascular events in women: prospective cohort study. BMJ (Clinical Research Ed.), 337, pp. a636. doi:10.1136/bmj.a636.
Kurth T, et al. Migraine, Vascular Risk, and Cardiovascular Events in Women: Prospective Cohort Study. BMJ. 2008 Aug 7;337:a636. PubMed PMID: 18687721.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Migraine, vascular risk, and cardiovascular events in women: prospective cohort study. AU - Kurth,Tobias, AU - Schürks,Markus, AU - Logroscino,Giancarlo, AU - Gaziano,J Michael, AU - Buring,Julie E, Y1 - 2008/08/07/ PY - 2008/8/9/pubmed PY - 2008/8/19/medline PY - 2008/8/9/entrez SP - a636 EP - a636 JF - BMJ (Clinical research ed.) JO - BMJ VL - 337 N2 - 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 (<or=1%, 2-4%, 5-9%, and >or=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. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/18687721/Migraine_vascular_risk_and_cardiovascular_events_in_women:_prospective_cohort_study_ L2 - http://www.bmj.com/cgi/pmidlookup?view=long&amp;pmid=18687721 DB - PRIME DP - Unbound Medicine ER -