Migraine with Aura Assoc w/ Stroke & Heart Dz Deaths
2 large prospective cohort studies
hemorrhagic stroke
individual risk is low
previous data suggested this finding
reports published online August 25 in the BMJ
Reykjavik Study
Larus S. Gudmundsson, doctoral student from U of Iceland
looked at impact of midlife migraine episodes in 18,725 men and women born between 1907 and 1935
study cohort started in 1967 by the Icelandic Heart Association to prospectively study CV dz
pts followed up for up to 40 years, to end of 07
median follow-up: 25.9 years
total: 470,990 person-years of data
overall: 10,358 deaths, 4323 from cv dz, 6035 from other causes.
adjusted for baseline risk factors, age, and sex
found: people with migraine with aura have incr risk for all-cause mortality and mortality from CAD & stoke
no increased risk was found for people with migraine without aura and people with nonmigraine headache
women with migraine with aura: also incr risk for mortality from noncv dz
added risk is low compared to conventional modifiable risk factors: smoking, hyperlipidemia, HTN
if you have migraine with aura, evaluate CV risk and act accordingly
future studies to consider whether meds txing migraine change cv risk
Women's Health Study
Tobias Kurth, MD, from Harvard Medical School, Boston, Massachusetts
27,860 women 45 years or older who were free from stroke or other major disease at study entry
5130 women (18%) reported hx of migraine
3612 reported migraine in previous year: "active"
40% of the women with active migraine reported having migraine with aura
mean 13.6 years of follow-up (377,711 patient years)
85 confirmed hemorrhagic strokes occurred
women with active migraine with aura have 2x more risk for hemorrhagic stroke than women w/o migraine
(adjusted hazard ratio, 2.25; 95% confidence interval, 1.11 - 4.54; P = .024)
4 additional hemorrhagic stroke events were attributable to migraine with aura/10,000 women/year
active migraine w/o aura, or non-active migraine-->no incr in risk
even with active migraine risk, risk is still very low
March 22, 2005 issue of Neurology
Kurth and colleagues reported 9-year follow-up findings from the Women's Health Study
migraine with aura was not associated with a greater risk for hemorrhagic stroke
systematic review and meta-analysis reported in the January 8, 2005, issue of the BMJ
Etminan
migraine was linked with a greater risk for ischemic stroke
association between migraine and cardiovascular mortality or all-cause mortality is not clear
population-based cohort study by Gudmundsson and colleagues
data from the Reykjavik Study
described by Sigurdsson and colleagues in the January 15, 1995, Annals of Internal Medicine
assesses whether migraine/aura is assoc w/ risk for mortality dt cv dz, non cv dz, all causes
prospective cohort study by Kurth and colleagues
data from the Women's Health Study
assesses whether migraine or aura status is associated with the risk for hemorrhagic stroke in women
NOT SORTED FROM HERE DOWN
Gudmundsson and colleagues
18,725 subjects (9044 men and 968 women) born in 1907 to 1935 were enrolled.
Questionnaires and measures were completed at a mean age of 53 years (age range, 33 - 81 years).
Median follow-up period was 25.9 years.
Categories were no headache (headache < once a month), migraine without aura, migraine with aura, and nonmigraine.
2023 participants (11%) reported migraines: 3% without aura and 8% with aura.
The main outcome measures were mortality from cardiovascular disease, noncardiovascular disease, and all causes.
10,358 deaths occurred: 4323 from cardiovascular disease and 6035 from other causes.
Cardiovascular deaths included 2810 from coronary heart disease, 927 from stroke, and 586 from other forms of cardiovascular disease.
Analysis adjusted for sex, age, body mass index, education, smoking, and blood pressure.
Migraine headache vs no headache was linked with an increased risk for all-cause mortality (HR, 1.15) and cardiovascular mortality (HR, 1.22), specifically death from coronary heart disease (HR, 1.22).
Migraine with aura vs no headache was linked with an increased risk for all-cause mortality (HR, 1.21) and cardiovascular disease mortality (HR, 1.27).
Migraine with aura was also linked with a greater risk for mortality from coronary heart disease (HR, 1.28).and stroke (HR, 1.40).
Women with migraine with aura had an increased risk for noncardiovascular disease mortality (HR, 1.19).
Migraine without aura and nonmigraine headache vs no headache were not linked with the risk for all-cause mortality or cardiovascular disease mortality.
Study limitations included no adjustment for vascular risk factors that might have developed later and lack of data on migraine treatment in use.
Kurth and colleagues
In the Women's Health Study, 39,876 female health professionals 45 years or older were randomly assigned to receive aspirin, vitamin E, both aspirin and vitamin E, or neither.
Eligibility criteria were no cardiovascular disease, cancer, or other major illnesses.
Women self-reported cardiovascular risk factors and variables at baseline, twice in the first year, and then annually.
Mean follow-up was 13.6 years.
27,860 women reported migraine information.
5130 (18%) had any history of migraine.
Of 3612 with active migraine in the previous year, 1435 (40%) reported an aura.
The main outcome measures were time to first hemorrhagic stroke and subtypes of hemorrhagic stroke.
Nonfatal stroke was defined as a new focal neurologic deficit of sudden onset that was attributed to a cerebrovascular event lasting for more than 24 hours.
Fatal stroke was confirmed by death certificate, hospital records, or relatives.
Stroke subtypes were assessed by clinical information and brain imaging studies.
Hemorrhagic stroke occurred in 85 women: 44 had intracerebral hemorrhages, 36 had subarachnoid hemorrhages, and 5 had unclear subtype.
The age-adjusted incidence of hemorrhagic stroke per 10,000 women per year was 6.3 for active migraine with aura, 2.5 for any migraine history, 2.3 for no migraine, 1.3 for previous migraine, and 0.8 for active migraine without aura.
Multivariable analysis adjusted for age, hypertension, smoking, body mass index, alcohol intake, and total cholesterol level.
Women with active migraine with aura vs those with no migraine history had an increased risk for hemorrhagic stroke (adjusted hazard ratio [HR], 2.25).
The age-adjusted risk for hemorrhagic stroke was higher for intracerebral vs subarachnoid hemorrhage (adjusted HR, 2.78) and for fatal vs nonfatal events (adjusted HR, 3.56).
Active migraine without aura and previous migraine were not linked with the risk for hemorrhagic stroke.
Study limitations included the low number of events and the need for confirmatory studies.
SOURCE
http://cme.medscape.com/viewarticle/727664?src=cmemp&uac=89474MT