Migraine, vascular risk, and cardiovascular events in women: prospective cohort study

Abstract

Objectives: To evaluate whether the association between migraine with aura and increased risk of cardiovascular disease is modified by vascular risk groups as measured by the Framingham risk score for coronary heart disease.

Design: Prospective cohort study.

Setting: Women's health study, United States.

Participants: 27 519 women who were free from cardiovascular disease at baseline with available information on the Framingham risk score and migraine status.

Main outcome measures: Time to major cardiovascular disease event (non-fatal myocardial infarction, non-fatal ischaemic stroke, death from ischaemic cardiovascular disease), myocardial infarction, and ischaemic stroke.

Results: At baseline, 3577 (13.0%) women reported active migraine, of whom 1418 (39.6%) reported migraine with aura. During 11.9 years of follow-up, there were 697 cardiovascular disease events. We stratified participants based on 10 year risk of coronary heart disease estimated from the Framingham risk score (<or=1%, 2-4%, 5-9%, and >or=10%). Compared with women without migraine, the age adjusted hazard ratios in women with active migraine with aura were 1.93 (95% confidence interval 1.45 to 2.56) for major cardiovascular disease, 1.80 (1.16 to 2.79) for ischaemic stroke, and 1.94 (1.27 to 2.95) for myocardial infarction. When stratified by Framingham risk score, the association between migraine with aura and major cardiovascular disease was strongest in the lowest risk score group. There was a diametric association pattern for ischaemic stroke and myocardial infarction. Compared with women without migraine, the age adjusted hazard ratios in women who reported migraine with aura in the lowest Framingham risk score group were 3.88 (1.87 to 8.08) for ischaemic stroke and 1.29 (0.40 to 4.21) for myocardial infarction. Hazard ratios in women with migraine with aura in the highest Framingham risk score group were 1.00 (0.24 to 4.14) for ischaemic stroke and 3.34 (1.50 to 7.46) for myocardial infarction. Women with migraine without aura were not at increased risk of ischaemic stroke or myocardial infarction in any of the Framingham risk score groups.

Conclusion: The association between migraine with aura and cardiovascular disease varies by vascular risk status. Information on history of migraine and vascular risk status might help to identify women at increased risk for specific future cardiovascular disease events.

Trial registration: Clinical trials NCT00000479.

Conflict of interest statement

Competing interests: TK has received funding from the National Institutes of Health, Bayer AG, McNeil Consumer and Specialty Pharmaceuticals, and Wyeth Consumer Healthcare; he is a consultant to i3 Drug Safety, and received an honorarium from Organon for contributing to an expert panel. MS has received funding from the Deutsche Forschungsgemeinschaft and an unrestricted research grant from Merck, Sharp and Dohme. GL has received funding from the National Institutes of Health and received honoraria from Pfizer and Lilly Pharmaceutical for speaking engagements in 2003. JMG has received funding and support from National Institutes of Health, BASF, DSM Pharmaceuticals, Wyeth Pharmaceuticals, McNeil Consumer Products and Pliva; received honoraria from Bayer and Pfizer for speaking engagements, and is a consultant for Bayer, McNeil Consumer Products, Wyeth Pharmaceuticals, Merck, Nutraquest, and GlaxoSmithKline. JEB has received funding and support from the National Institutes of Health and Dow Corning Corporation; research support from Bayer Heath Care and the Natural Source Vitamin E Association; and an honoraria from Bayer for speaking engagements.

Ethical approval: Institutional review board of Brigham and Women’s Hospital, Boston, MA USA.

Figures

Age adjusted association between migraine with aura and ischaemic stroke and myocardial infarction according to 10 year risk of coronary heart disease estimated by Framingham risk score. Reference group was women without history of migraine