Association of Migraine With Aura and Other Risk Factors With Incident Cardiovascular Disease in Women

Abstract

Importance: Migraine with aura is known to increase the risk of cardiovascular disease (CVD). The absolute contribution of migraine with aura to CVD incidence in relation to other CVD risk factors remains unclear.

Objective: To estimate the CVD incidence rate for women with migraine with aura relative to women with other major vascular risk factors.

Design, setting, and participants: Female health professionals in the US (the Women's Health Study cohort) with lipid measurements and no CVD at baseline (1992-1995) were followed up through December 31, 2018.

Exposures: Self-reported migraine with aura compared with migraine without aura or no migraine at baseline.

Main outcomes and measures: The primary outcome was major CVD (first myocardial infarction, stroke, or CVD death). Generalized modeling procedures were used to calculate multivariable-adjusted incidence rates for major CVD events by risk factor status that included all women in the cohort.

Results: The study population included 27 858 women (mean [SD] age at baseline, 54.7 [7.1] years), among whom 1435 (5.2%) had migraine with aura and 26 423 (94.8%) did not (2177 [7.8%] had migraine without aura and 24 246 [87.0%] had no migraine in the year prior to baseline). During a mean follow-up of 22.6 years (629 353 person-years), 1666 major CVD events occurred. The adjusted incidence rate of major CVD per 1000 person-years was 3.36 (95% CI, 2.72-3.99) for women with migraine with aura vs 2.11 (95% CI, 1.98-2.24) for women with migraine without aura or no migraine (P < .001). The incidence rate for women with migraine with aura was significantly higher than the adjusted incidence rate among women with obesity (2.29 [95% CI, 2.02-2.56]), high triglycerides (2.67 [95% CI, 2.38-2.95]), or low high-density lipoprotein cholesterol (2.63 [95% CI, 2.33-2.94]), but was not significantly different from the rates among those with elevated systolic blood pressure (3.78 [95% CI, 2.76-4.81]), high total cholesterol (2.85 [95% CI, 2.38-3.32]), or family history of myocardial infarction (2.71 [95% CI, 2.38-3.05]). Incidence rates among women with diabetes (5.76 [95% CI, 4.68-6.84]) or who currently smoked (4.29 [95% CI, 3.79-4.79]) were significantly higher than those with migraine with aura. The incremental increase in the incidence rate for migraine with aura ranged from 1.01 additional cases per 1000 person-years when added to obesity to 2.57 additional cases per 1000 person-years when added to diabetes.

Conclusions and relevance: In this study of female health professionals aged at least 45 years, women with migraine with aura had a higher adjusted incidence rate of CVD compared with women with migraine without aura or no migraine. The clinical importance of these findings, and whether they are generalizable beyond this study population, require further research.

Figure.. Adjusted Incidence Rates for Major Cardiovascular Disease Events per 1000 Person-Years in a Study of the Association of Migraine With Aura With Incident Cardiovascular Disease in Women

The vertical line indicates the adjusted incidence rate for migraine with aura. Values to the left of the vertical line indicate lower and values to the right indicate higher adjusted incident rates of major cardiovascular disease compared with the incidence rate of migraine with aura. Adjusted for all factors listed as well as age (5-year groups), alcohol use, exercise, hypertensive treatment, ever use of hormones, and premenopausal status. Because 2 different approaches were used for categorizing covariates in the multivariable models, the estimated adjusted incidence rates differ slightly in the Figure (in which some covariates were categorized as polychotomous) and in Table 2 (in which all covariates were categorized as dichotomous). ^aP value was calculated using a χ² test. HDL indicates high-density lipoprotein; BP, blood pressure; MI, myocardial infarction.