How Does Migraine With Aura Compare With Other CVD Risk Factors?

Compared with traditional cardiovascular disease (CVD) risk factors such as obesity and high triglycerides, migraine with aura is associated with a higher incidence rate of CVD among female health professionals aged at least 45 years, according to a study published in JAMA.

“Migraine with aura has been consistently associated with increased risk of overall and specific CVD events on the relative scale, and migraine has been included in a risk score for CVD,” the authors noted. However, the absolute contribution of migraine with aura to CVD incidence in relation to other major vascular risk factors is unclear.

Researchers analyzed data from 27,858 US female health professionals participating in the Women’s Health Study, launched in 1992. The randomized placebo-controlled study was designed to examine effects of aspirin and vitamin E on prevention of cancer and CVD. Those with available lipid measurements and no CVD at baseline (1992-1995) were included in the current study and followed-up with through December 2018.

Multivariable-adjusted incidence rates for major CVD (first myocardial infarction, stroke, or CVD death) were calculated using generalized modeling procedures. Of the nearly 30,000 women enrolled in the study, 1435 (5.2%) self-reported migraine with aura at baseline, while 2177 (7.8%) reported migraine without aura, and 24,246 (87%) did not experience migraine the year before baseline.

Average age at baseline was 54.7 years, while average mean follow-up period was 22.6 years. Throughout the study, 1666 major CVD events, 887 strokes (fatal and nonfatal), 629 myocardial infarctions (fatal and nonfatal), and 391 deaths due to CVD took place. Data revealed the following adjusted incidence rates for major CVD per 1000 person-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&thinsp; <&thinsp;.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 high-density lipoprotein cholesterol (95% CI, 2.33-2.94)

Incidence rate of CVD among migraineurs with aura was not significantly different from those with elevated systolic blood pressure, high total cholesterol, or family history of myocardial infarction. Of all the risk factors assessed, incidence rates among women with diabetes or current smokers were significantly higher than migraineurs with aura at 5.76 per 1000 person-years and 4.29, respectively.

In addition, researchers found “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.”

Impairments of the endovascular function, genetic predisposition to both conditions, and inflammatory processes have all been proposed as contributing factors increaseing risk of CVD among those with migraine with aura.

Due to the fact migraine and vascular risk factors were self-reported, misclassification may have taken place. Changes in risk factors over time were also not taken into account throughout the study, while information on management of the conditions listed was not available. Investigators caution results may not be generalizable to larger populations, particularly men.

Future research ought to be conducted on these findings to better understand their clinical importance and generalizability, authors conclude.

Reference:

Kurth T, Rist PM, Ridker PM, et al. Association of migraine with aura and other risk factors with incident cardiovascular disease in women. JAMA. 2020;323(22):2281-2289. doi:10.1001/jama.2020.7172