Migraine with aura associated with increased risk of cardiovascular disease

Women who experience migraines with aura have an increased risk of cardiovascular events, a new study has found. However, the researchers report that migraine without aura was not associated with increased risk.Writing in the latest issue of JAMA, Dr Tobias Kurth and colleagues (Brigham and Women's Hospital, Boston) note that migraine with aura has been associated with an adverse cardiovascular risk profile and prothrombotic factors that, along with migraine-specific physiology, may increase the risk of vascular events.The researchers therefore evaluated the association between migraine and subsequent risk of cardiovascular events in 27 840 US women aged 45 years or older who were participating in the Women's Health Study, were free of CVD and angina at study entry (1992-1995), and who had information on self-reported migraine and aura status, and lipid measurements.At baseline, 5125 women (18.4%) reported a history of migraine; of the 3610 with active migraine (migraine in the prior year), 1434 (39.7%) had aura symptoms. During an average of 10 years of follow-up, 580 major cardiovascular events occurred. Any history of migraine was associated with an increased risk of cardiovascular events. Kurth and colleagues report that this increased risk was strikingly different according to aura status. Compared with no migraine history, active migraine with aura was associated with a significantly increased risk of subsequent major cardiovascular events, ischemic stroke, myocardial infarction, coronary revascularization, angina, and death due to ischemic CVD after a mean follow-up of 10 years. These increased risks, which remained after adjusting for a large number of cardiovascular risk factors, ranged from a 1.7-fold increase for coronary revascularization to a 2.3-fold increase for cardiovascular death. Women with prior migraine had increased risk of coronary revascularization and angina. In contrast, women who reported active migraine without aura did not have significantly increased risk for any ischemic vascular event. Migraine with aura has also been associated with a more detrimental cardiovascular risk profile, including elevated cholesterol levels, higher blood pressure, higher likelihood of hypertension, and increased Framingham risk score for coronary heart disease. "Thus, it is possible that migraine with aura may be a characteristic that identifies women at increased risk of progressive atherosclerosis and subsequent vascular events," Kurth and colleagues write in their paper published in JAMA. In an accompanying editorial, Drs Richard Lipton and Marcelo Bigal, (Albert Einstein College of Medicine, New York) note that while migraine with aura is well established as a risk factor for ischemic stroke, the relationship of migraine and ischemic cardiac disease has been less clear and the study by Kurth and colleagues "changes this landscape".They note that most migraine patients have migraine without aura and, therefore, are not at increased risk of CVD. "For patients with migraine with aura, clinicians should have heightened vigilance for modifiable cardiovascular risk factors, such as hypertension, hyperlipidemia, and smoking."They call for Kurth et al's findings to be confirmed and assessed in men and in younger age groups of women....