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Migraine and risk of cardiovascular diseases: Danish population based matched cohort study
Kasper Adelborg1, Szimonetta Komjáthiné Szépligeti2, Louise Holland-Bill2
1Department of Clinical Epidemiology, Aarhus University Hospital, Denmark kade@clin.au.dk.
Insights
Migraine patients face higher risks for heart attack, stroke, and blood clots compared to the general population. These cardiovascular risks are significant, especially in the years following a migraine diagnosis.
Area of Science:
- Cardiovascular epidemiology
- Neurology
- Public health
Background:
- Migraine is a prevalent neurological disorder.
- The association between migraine and cardiovascular disease (CVD) risk requires further investigation.
Purpose of the Study:
- To investigate the risks of major cardiovascular events in individuals with migraine compared to a matched general population cohort.
- To identify specific cardiovascular outcomes associated with migraine.
Main Methods:
- A nationwide, population-based cohort study was conducted using Danish registry data from 1995 to 2013.
- 51,032 patients with migraine were compared to 510,320 individuals from the general population, matched for age, sex, and calendar year.
- Cox regression analysis was used to calculate comorbidity-adjusted hazard ratios for cardiovascular outcomes.
Main Results:
- Patients with migraine exhibited higher cumulative incidences for myocardial infarction, ischemic stroke, hemorrhagic stroke, venous thromboembolism, and atrial fibrillation/flutter compared to the general population.
- Migraine was significantly associated with increased risks of myocardial infarction (aHR 1.49), ischemic stroke (aHR 2.26), hemorrhagic stroke (aHR 1.94), venous thromboembolism (aHR 1.59), and atrial fibrillation/flutter (aHR 1.25).
- Associations were stronger in the short term post-diagnosis, in patients with aura, and in women. Risks for peripheral artery disease and heart failure were not significantly increased.
Conclusions:
- Migraine is associated with a substantially increased risk of several major cardiovascular diseases, including myocardial infarction, stroke, venous thromboembolism, and atrial fibrillation/flutter.
- Migraine should be considered a significant risk factor for cardiovascular disease.
- Further research into the underlying mechanisms and targeted preventive strategies for cardiovascular events in migraine patients is warranted.
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.
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