Migraine does not affect CVD risk in postmenopausal women
A history of migraine does not appear to affect the risk of cardiovascular disease (CVD) in postmenopausal women, a large observational study presented at the American Headache Society conference (AHS 2019) showed.
The study population consisted of 71,441 postmenopausal women aged 50-79 years enrolled in the Women’s Health Initiative Study. The women were followed up annually for 22 years. Of these, 10.7 percent (n=7,616) had a history of migraine. Comorbidities such as hypertension, hyperlipidaemia, and obesity affected a comparable proportion of women with and without migraine at baseline.
Women with a history of migraine were more likely to report having night sweats (standardized mean difference [SMD], 0.134) and hot flashes (SMD, 0.155), and had undergone a bilateral oophorectomy (SMD, 0.123) than those without migraine.
The overall incidence of a composite of CVD events* over the follow-up period did not significantly differ between women with and without a history of migraine (n=617 vs 5,672, hazard ratio [HR], 0.99, 95 percent confidence interval [CI], 0.91–1.08; p=0.793). [AHS 2019, OR01]
The lack of significant difference pertained to the incidence of stroke (n=211 vs 1,943, HR, 1.03, 95 percent CI, 0.89–1.19; p=0.679) as well as myocardial infarction (MI; n=187 vs 1,723, HR, 0.99, 95 percent CI, 0.85–1.16; p=0.926).
“The evidence for the relationship between migraine and CVD has been conflicting,” said the study authors led by Assistant Professor Jelena Pavlovic from the Albert Einstein College of Medicine in New York, US.
A previous study conducted using data of women aged 25–42 years enrolled in the Nurses’ Health Study II showed that a history of migraine was associated with a range of CVDs including MI and stroke, angina or coronary revascularization procedures, and CVD-related death. [BMJ 2016;353:i2610]
Another study showed that only migraine with aura was associated with an elevated risk of CVD in women aged ≥45 years, with active migraine with aura tied to an elevated risk of stroke. [Neurology 2009;73:581-588] Another study comprising women aged ≥45 years enrolled in the Women’s Health Study showed that active migraine without aura was not associated with any vascular event or angina, while active migraine with aura was tied to an elevated risk of major CVD, MI, ischaemic stroke, ischaemic CVD-related death, coronary revascularization, and angina. [JAMA 2006;296:283-291]
The migraine-CVD relationship appears to be affected by age, aura status, and specific CVD outcome, said Pavlovic and co-authors.
“While risk appears to be the highest in younger women, the relationship has so far not been extensively examined in older postmenopausal women who are at the highest risk of experiencing CVD events,” they added.
“[This study showed that a] history of migraine does not appear to be correlated with the risk of stroke, MI, and composite CVD events … in this large longitudinal cohort of older postmenopausal women,” they said.