Migraine Is Associated With Risk for Cardiovascular Disease
Patients with migraines have an increased risk for cardiovascular disease and its risk factors, including diabetes, hypertension, and high cholesterol, according to a report in the February 10 online Neurology. Prior research had found an association between cardiovascular disease and migraine with aura; however, this study by Marcelo E. Bigal, MD, PhD, of the Department of Neurology, Albert Einstein College of Medicine, New York City, and colleagues found a correlation between cardiovascular disease and migraines with or without aura.
The investigators queried a sample of 9,107 migraineurs and 10,000 potential controls from the American Migraine Prevalence and Prevention (AMPP) study, using a validated mailed questionnaire to obtain self-reported cardiovascular events, medical diagnoses, treatments, comorbidities, and other variables. Complete responses were received from 6,102 migraineurs (67% response rate) and 5,243 controls (52.4% response rate). Compared with controls, subjects were more likely to be female (80.3% vs 53%), have a lower income, and be older (median age, 24.0 vs 20.4).
A Link to Cardiovascular Disease
“Providers and patients should understand that the risk is small, and not become overly concerned,” Dr. Bigal told Neurology Reviews. “Although small, the risk is existent, so providers should be extra vigilant in screening for cardiovascular status in individuals with migraine—nothing exaggerated, but just paying extra attention. Additionally, patients should be motivated to achieve a healthy lifestyle by eating properly, reaching a good BMI, exercising, and not smoking.”
A Bidirectional Relationship?
In an accompanying editorial, Hans-Christoph Diener, MD, Department of Neurology Chairman, University Duisburg-Essen, and Judith U. Harrer, MD, of the Caritasklinik St. Theresia, Saarbrücken, both in Germany, noted that the results of this study support the hypothesis that endothelial function outside the brain might be compromised in migraine patients. “This poses a ‘chicken-or-the-egg’ problem,” they wrote. “Is there a direct link between migraine and CVD risk factors, or is there a shared pathogenesis, or a shared genetic basis for both?”
According to Drs. Diener and Harrer, the study raises both conclusions and additional questions. In particular, they commented that the “long-held perception” that migraineurs lead a healthier lifestyle is incorrect, as noted by an increased risk of diabetes, high blood pressure, and high cholesterol found in the study. The editorialists also pointed out that it is uncertain how this new information correlates to obesity, a known risk factor among patients who transition from episodic to chronic migraines.
Another question is whether optimal and effective preventive or acute migraine therapies can help prevent strokes and white matter lesions. “A prospective study to investigate this would be almost impossible to do, because it would need to run for more than 10 years,” they noted. “Whether the relatively small number of vascular events in migraine patients justifies such an investment and effort is another question.”
Overall migraine, with or without aura, was associated with an increased risk for myocardial infarction (odds ratio [OR], 2.19) and peripheral arterial disease (OR, 2.86). The researchers, however, found that migraine with aura represented a higher risk for both complications compared with migraine without aura and was also associated with a higher risk of stroke (OR, 3.14). Compared with controls, patients with migraines were more likely to be diagnosed with diabetes (OR, 1.4), hypertension (OR, 1.4), and high cholesterol (OR, 1.4).
Because migraine was associated with both cardiovascular disease and its risk factors and some migraine medications are vasoconstrictive, the researchers adjusted multivariate models for gender, age, disability, and triptan use, as well as cardiovascular disease risk factors. This analysis found that migraines were linked to a 2.2-fold increased risk of myocardial infarction, a 1.5-fold increased stroke risk, and a 2.69-fold increased risk for claudication.
“Our study clearly suggests that migraine without aura is also associated with heart attack (but not stroke), and risk factors for cardiovascular events,” the researchers wrote. “For established events, the magnitude of risk was inferior to migraine with aura, but existent.”