Women with ischemic heart disease and history of migraine headaches are at increased’ risk for future cardiovascular (CV) events, according to a study published online in the American Journal of Medicine.1
A team of researchers led by Cecil Rambarat, MD, from the Department of Medicine at the University of Florida in Gainesville, analyzed data from 917 participants in the Women’s Ischemia Syndrome Evaluation (WISE) study2 (mean age, 58 years) who presented with symptoms of myocardial ischemia, underwent structured data collection and coronary angiography, and had information available pertaining to migraine headaches.
In an interview with Cardiology Advisor, Dr Rambarat said the study was conducted to “expand upon previous literature suggesting an association between migraine headache and stroke, in addition to cardiovascular disease.”
A prior midterm follow-up analysis of this cohort at 4.4 years found that a history of migraine headache was not associated with increased CV events. The current analysis was designed to extend the investigation to longer-term events. All study participants had all-cause mortality data available for a median of 9.5 years, and 888 participants had nonfatal CV event data available for a median of 6.5 years.
Of the 917 participants, 224 (24.4%) reported a history of migraine headache. These participants had an increased adjusted hazard ratio (HR) for a CV event (CV death, nonfatal myocardial infarction [MI], heart failure, or stroke [HR, 1.83; 95% CI, 1.22-2.75]). Although the adjusted HR for individual end points of death from all causes, CV death, nonfatal MI, and heart failure did not differ significantly between the 2 groups, there was a more than 2-fold increase in the incidence of stroke in women with a history of migraine headache (HR, 2.33; 95% CI, 1.16-4.68).
The researchers noted that history of migraine headache has been linked particularly with ischemic stroke, and that the association is strongest among patients who have migraine with aura. Increased migraine frequency amplifies this risk. “The absence of a statistically significant association with [CV] outcomes such as [MI], heart failure, angina, or death may be in part due to inclusion of a broader population of migraine headache in our study, who were not further characterized to be with or without aura,” they wrote.
Dr Rambarat said that the pathophysiology of this association needs further elucidation. “Both have endothelial dysfunction in common. And people with migraine headache have higher levels of inflammatory markers, placing them at increased risk [for] stroke and cardiovascular events,” he said.
Ki Park, MD, assistant professor in the Division of Cardiovascular Medicine also at the University of Florida, who was not involved in the study, commented, “this was a very important study” that suggests “when you are trying to assess CV risk in women, it is important to consider nontraditional CV risk factors that might include migraine, as well as other conditions that affect women, such as autoimmune diseases or pregnancy.”
Dr Park also pointed out a study limitation: “The study was conducted in a very specific group of women, so it may not be generalizable to the entire population or to all women per se.”
Dr Rambarat agreed with the study’s clinical implications. “I think we need to pay more attention to women with a history of migraine headache.”
“One of the questions is whether we should start primary prevention in these women at an early age,” Dr Rambarat added. “For example, aspirin prevention usually starts at age 55 in women with risk factors for stroke. This adds to the entire picture.”
- Rambarat CA, Elgendy IY, Johnson BD, et al. Migraine headache and long term cardiovascular outcomes: an extended follow-up of the Women’s Ischemia Syndrome Evaluation [published online January 18, 2017]. Am J Med. doi: 10.1016/j.amjmed.2016.12.028
- Bairey Merz CN, Kelsey SF, Pepine CJ. The Women’s Ischemia Syndrome Evaluation (WISE) study: protocol design, methodology, and feasibility report. J Am Coll Cardiol. 1999;33(6):1453-1461.