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. 2016 May 31:353:i2610.
doi: 10.1136/bmj.i2610.

Migraine and risk of cardiovascular disease in women: prospective cohort study

Tobias Kurth  1 , Anke C Winter  2 , A Heather Eliassen  3 , Rimma Dushkes  4 , Kenneth J Mukamal  5 , Eric B Rimm  6 , Walter C Willett  7 , JoAnn E Manson  8 , Kathryn M Rexrode  4
Affiliations

Migraine and risk of cardiovascular disease in women: prospective cohort study

Tobias Kurth et al. BMJ. .

Erratum in

Abstract

Objective: To evaluate the association between migraine and incident cardiovascular disease and cardiovascular mortality in women.

Design: Prospective cohort study among Nurses' Health Study II participants, with follow-up from 1989 and through June 2011.

Setting: Cohort of female nurses in United States.

Participants: 115 541 women aged 25-42 years at baseline and free of angina and cardiovascular disease. Cumulative follow-up rates were more than 90%.

Main outcome measures: The primary outcome of the study was major cardiovascular disease, a combined endpoint of myocardial infarction, stroke, or fatal cardiovascular disease. Secondary outcome measures included individual endpoints of myocardial infarction, stroke, angina/coronary revascularization procedures, and cardiovascular mortality.

Results: 17 531 (15.2%) women reported a physician's diagnosis of migraine. Over 20 years of follow-up, 1329 major cardiovascular disease events occurred and 223 women died from cardiovascular disease. After adjustment for potential confounding factors, migraine was associated with an increased risk for major cardiovascular disease (hazard ratio 1.50, 95% confidence interval 1.33 to 1.69), myocardial infarction (1.39, 1.18 to 1.64), stroke (1.62, 1.37 to 1.92), and angina/coronary revascularization procedures (1.73, 1.29 to 2.32), compared with women without migraine. Furthermore, migraine was associated with a significantly increased risk for cardiovascular disease mortality (hazard ratio 1.37, 1.02 to 1.83). Associations were similar across subgroups of women, including by age (<50/≥50), smoking status (current/past/never), hypertension (yes/no), postmenopausal hormone therapy (current/not current), and oral contraceptive use (current/not current).

Conclusions: Results of this large, prospective cohort study in women with more than 20 years of follow-up indicate a consistent link between migraine and cardiovascular disease events, including cardiovascular mortality. Women with migraine should be evaluated for their vascular risk. Future targeted research is warranted to identify preventive strategies to reduce the risk of future cardiovascular disease among patients with migraine.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work; TK has received investigator initiated research funding from the French National Research Agency, the US National Institutes of Health, and the University of Bordeaux and has received honorariums from the BMJ and Cephalalgia for editorial services; ACW is supported by funds from Washington University School of Medicine, the Barnes-Jewish Hospital Foundation, and Siteman Cancer Center and has received funding from the Craig H Neilsen Foundation and the National Institutes of Health; AHE, KJM, EBR, WCW, JEM, and KMR receive funding by grants from the National Institutes of Health; no other relationships or activities that could appear to have influenced the submitted work.

Comment in

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