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Migraine, Vascular Risk, and Cardiovascular Events in Women
Kurth T, Schurks M, et al.
Posted: February 2009  
BMJ.  2008;337


Objective:   To evaluate whether the association between migraine with aura and increased risk of cardiovascular disease is modified by vascular risk groups.

Participants:   In total, 27,519 women who were free from cardiovascular disease.

Main Outcome Measures:   Time to major cardiovascular disease event (nonfatal myocardial infarction, nonfatal ischemic stroke, death from ischemic cardiovascular disease), myocardial infarction and ischemic stroke.

Results:   At baseline 3577 women reported active migraine, of whom 1418 reported migraine with aura. During 11.9 years of follow-up there were 697 cardiovascular disease events. We stratified participants based on 10 year risk of coronary heart disease Compared with women without migraine, the age adjusted hazard ratios in women with active migraine with aura were 1.93 for major cardiovascular disease, 1.80 for ischemic stroke, and 1.94 for myocardial infarction. The association between migraine with aura and major cardiovascular disease was strongest in the lowest risk score group. There was a diametric association pattern for ischemic stroke and myocardial infarction. Compared with women without migraine, the age adjusted hazard ratios in women who reported migraine with aura were 3.88 for ischemic stroke and 1.29 for myocardial infarction. Hazard ratios in women with migraine with aura were 1.00 for ischemic stroke and 3.34 for myocardial infarction. Women with migraine without aura were not at increased risk of ischemic stroke or myocardial infarction.

Conclusion:   The association between migraine with aura and cardiovascular disease varies by vascular risk status. Information on history of migraine and vascular risk status might help to identify women at increased risk of ischemic stroke or myocardial infarction.