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Published on: June 2, 2014
Menopausal status modifies the association between migraine and cardiovascular disease risk: a nationwide cohort
Do Yeon Kim1, Kyungdo Han2, Jeen Hwa Lee3
1Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
Background:
To evaluate whether menopausal status modifies the association between migraine and cardiovascular disease (CVD) risk in women, using both relative and absolute risk measures.
Methods:
We conducted a nationwide cohort study using Korean National Health Insurance Service data. Women aged ≥ 40 years who underwent the 2009 health screening and had no prior CVD (myocardial infarction or stroke) were included. Migraine was defined by using ICD-10 diagnostic codes. Menopausal status was determined from questionnaire-based reproductive history and prespecified as an effect modifier. Incident CVD and cardiovascular death were ascertained. Multivariable Cox models were used to estimate hazard ratios (HRs).
Results:
Among 2,156,733 women, 923,517 were premenopausal and 1,233,216 postmenopausal. In premenopausal women, CVD incidence was higher in those with migraine than in those without migraine (2.22 vs. 1.38 per 1,000 person-years), with a higher risk after multivariable adjustment (HR 1.53, 95% CI 1.42-1.66). In postmenopausal women, CVD incidence was also higher among those with migraine (9.53 vs. 7.50 per 1,000 person-years), although the relative association was attenuated but remained significant (HR 1.20, 95% CI 1.17-1.23). Accordingly, the crude incidence rate difference associated with migraine was larger after menopause (2.03 vs. 0.84 per 1,000 person-years). The relative associations between migraine and cardiovascular outcomes were stronger in premenopausal women, whereas larger absolute risk differences were observed in postmenopausal women. This pattern was observed for CVD, myocardial infarction, and ischemic stroke, but not for cardiovascular death.
Conclusion:
Migraine was associated with increased CVD risk in women. Relative associations were stronger before menopause, whereas absolute excess incidence was greater after menopause. These findings highlight the importance of considering migraine in cardiovascular risk assessment across the female life course, including after menopause.
