Study Suggests that Cardiovascular Risk Factors Tend to Cluster in Migraine Patients
2013 AAN Highlight: Study Suggests that Cardiovascular Risk Factors Tend to Cluster in Patients with Migraine
The link between heart disease and stroke and migraine, and particularly migraine with aura, is well established. Two recent systematic reviews and meta-analyses found that patients with migraine, particularly those with aura, face over twice the risk for ischemic stroke compared with the general population.1,2 Another recent case-control study conducted in the US found that individuals with migraine had over double the risk for myocardial infarction (MI) and claudication and one and a half times the risk for stroke compared with the general population. Increased risk for MI, stroke, and claudication was highest among patients with migraine with aura.3
Results from new studies that were presented at the 2013 American Academy of Neurology annual meeting in San Diego on March 16-23 add to this body of research linking migraine with increased cardiovascular risk. Kurth and colleagues reported results from a study that evaluated the contribution of migraine with aura to the incidence of cardiovascular disease (CVD) in a large prospective cohort of over 25,000 healthy women 45 years of age or older.4 Migraine with aura, which affected 1,435 women in the cohort, was a found to contribute strongly to risk of cardiovascular events. It was the second strongest single contributing CVD risk factor, with an overall incidence rate of 7.9 per 1,000 women per year, after systolic blood pressure ≥180 mmHg (9.8 per 1,000 women per year), ahead of diabetes, family history of MI, current smoking, and body mass index ≥35 kg/m2. The study concluded that while the combination of traditional risk factors, including high blood pressure, diabetes, family history of MI, smoking, and obesity, make the strongest contribution to CVD risk, migraine with aura is itself a strong relative contributing factor to increased CVD risk.
Another study by Dave and colleagues examined the relationship between migraine with aura and infarct size in acute stroke.5 The study, which was conducted in 139 patients who presented to a single tertiary care hospital with possible or confirmed acute stroke, found a significant direct correlation between history of migraine with aura and infarct volume, with infarct volume for patients positive for migraine with aura 2.69 times larger compared with patients without a history of migraine with aura (P<0.0001).
While results from these new studies adds to the evidence already linking migraine with increased risk for CVD, an equally important message that is emerging from this body of research is that recognized CVD risk factors, including high blood pressure, diabetes, high cholesterol, and others, tend to cluster in patients with migraine and particularly in those with migraine with aura. This is what was confirmed by Bigal and colleagues in a study published in Neurology in 2010, which found that individuals with migraine were almost 1.5 times more likely to have diabetes, hypertension, and elevated cholesterol compared with non-migraine controls. Migraine with aura had the strongest association with these CVD risk factors, including the additional CVD risk factor of smoking.3 Likewise, a recent cross-sectional case control study including 360 individuals with migraine (151 with aura) and 617 non-migraine controls found that individuals with migraine, and especially those with aura, were more likely to have diabetes, to smoke, and to have modestly decreased HDL-cholesterol than non-migraine controls.6
The positive takeaway message from these data, for health providers and patients, alike, is that many of these CVD risk factors are modifiable, including smoking, hypertension, elevated cholesterol, and diabetes, and that patients with migraine can and should monitor their CVD risk closely and use proven strategies, such as diet, exercise, smoking cessation, and medication, to manage this risk.
How much has your migraine disease changed or evolved over time?