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Migraine with visual aura is a risk factor for incident atrial fibrillation: A cohort study
Souvik Sen1, X Michelle Androulakis2, Viktoriya Duda2
1From the Department of Neurology (S.S., X.M.A., V.D., T.T.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Medicine (L.Y.C.), University of Minnesota, Minneapolis; Department of Epidemiology and Internal Medicine (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Cardiology (J.M.), Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Medical Center, PA; Department of Epidemiology (A.T.M.), Arnold School of Public Health, University of South Carolina, Columbia; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; and Department of Epidemiology (W.D.R.), Gilling's School of Public Health, University of North Carolina, Chapel Hill. Souvik.Sen@uscmed.sc.edu.
Objective:
Migraine with visual aura is associated with cardioembolic stroke risk. The aim of this study was to test association between migraine with visual aura and atrial fibrillation (AF), in the Atherosclerosis Risk in Communities study.
Methods:
In the Atherosclerosis Risk in Communities study, a longitudinal, community-based cohort study, participants were interviewed for migraine history in 1993-1995 and were followed for incident AF through 2013. AF was adjudicated using ECGs, discharge codes, and death certificates. Multivariable Cox proportional hazards models were used to study the relation between migraine and its subtypes with incident AF, compared with controls without headaches. Mediation analysis was conducted to test whether AF was a mediator of migraine with visual aura-associated stroke risk.
Results:
Of 11,939 participants assessed for headache and without prior AF or stroke, 426 reported migraines with visual aura, 1,090 migraine without visual aura, 1,018 nonmigraine headache, and 9,405 no headache. Over a 20-year follow-up period, incident AF was noted in 232 (15%) of 1,516 with migraine and 1,623 (17%) of 9,405 without headache. After adjustment for multiple confounders, migraine with visual aura was associated with increased risk of AF compared to no headache (hazard ratio 1.30, 95% confidence interval 1.03-1.62) as well as when compared to migraine without visual aura (hazard ratio 1.39, 95% confidence interval 1.05-1.83). The data suggest that AF may be a potential mediator of migraine with visual aura-stroke risk.
Conclusions:
Migraine with aura was associated with increased risk of incident AF. This may potentially lead to ischemic strokes.
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