Compared with traditional cardiovascular disease (CVD) risk factors, such as obesity and high triglycerides, migraine with aura is associated with a higher incidence rate of CVD among female health professionals aged at least 45 years, according to a study published in JAMA.
Compared with traditional cardiovascular disease (CVD) risk factors such as obesity and high triglycerides, migraine with aura is associated with a higher incidence rate of CVD among female health professionals aged at least 45 years, according to a study published in JAMA.
“Migraine with aura has been consistently associated with increased risk of overall and specific CVD events on the relative scale, and migraine has been included in a risk score for CVD,” the authors noted. However, the absolute contribution of migraine with aura to CVD incidence in relation to other major vascular risk factors is unclear.
Researchers analyzed data from 27,858 US female health professionals participating in the Women’s Health Study, launched in 1992. The randomized placebo-controlled study was designed to examine effects of aspirin and vitamin E on prevention of cancer and CVD. Those with available lipid measurements and no CVD at baseline (1992-1995) were included in the current study and followed-up with through December 2018.
Multivariable-adjusted incidence rates for major CVD (first myocardial infarction, stroke, or CVD death) were calculated using generalized modeling procedures. Of the nearly 30,000 women enrolled in the study, 1435 (5.2%) self-reported migraine with aura at baseline, while 2177 (7.8%) reported migraine without aura, and 24,246 (87%) did not experience migraine the year before baseline.
Average age at baseline was 54.7 years, while average mean follow-up period was 22.6 years. Throughout the study, 1666 major CVD events, 887 strokes (fatal and nonfatal), 629 myocardial infarctions (fatal and nonfatal), and 391 deaths due to CVD took place. Data revealed the following adjusted incidence rates for major CVD per 1000 person-years:
Incidence rate of CVD among migraineurs with aura was not significantly different from those with elevated systolic blood pressure, high total cholesterol, or family history of myocardial infarction. Of all the risk factors assessed, incidence rates among women with diabetes or current smokers were significantly higher than migraineurs with aura at 5.76 per 1000 person-years and 4.29, respectively.
In addition, researchers found “the incremental increase in the incidence rate for migraine with aura ranged from 1.01 additional cases per 1000 person-years when added to obesity to 2.57 additional cases per 1000 person-years when added to diabetes.”
Impairments of the endovascular function, genetic predisposition to both conditions, and inflammatory processes have all been proposed as contributing factors increaseing risk of CVD among those with migraine with aura.
Due to the fact migraine and vascular risk factors were self-reported, misclassification may have taken place. Changes in risk factors over time were also not taken into account throughout the study, while information on management of the conditions listed was not available. Investigators caution results may not be generalizable to larger populations, particularly men.
Future research ought to be conducted on these findings to better understand their clinical importance and generalizability, authors conclude.
Reference:
Kurth T, Rist PM, Ridker PM, et al. Association of migraine with aura and other risk factors with incident cardiovascular disease in women. JAMA. 2020;323(22):2281-2289. doi:10.1001/jama.2020.7172
The Pivotal Role of Payers in Improving Health Equity, Maternal Health Care in the US
March 26th 2024A presentation at the Greater Philadelphia Business Coalition on Health's 2024 Women’s Health Summit discussed how payers, including employers and public entities, can strategically influence health care purchasing to prioritize maternal health and equity.
Read More
Addressing Maternal Mortality in Medicaid by Focusing on Mental Health
February 15th 2023On this episode of Managed Care Cast, we speak with Inland Empire Health Plan, a managed care plan serving more than 1.4 million residents on Medi-Cal in California, about a new maternal mental health program aimed at supporting new mothers, both before they give birth and afterward.
Listen
For National Women’s Health Week, One Company Emphasizes Cardiovascular Risk Management
May 10th 2022On this episode of Managed Care Cast, we speak with Joanne Armstrong, MD, MPH, vice president and chief medical officer for Women’s Health and Genomics at CVS Health, on the distinct pathophysiology of cardiovascular disease in women and how her own health experiences have influenced her perspective on cardiovascular disease management.
Listen
What We’re Reading: Historic Low of Uninsured; Youth Gender Treatments; Birth Control Recall
August 4th 2023A record low of 7.7% of Americans had no health insurance at the start of 2023; the American Academy of Pediatrics renewed its backing of gender care for children while requesting a research review; 2 lots of an oral contraceptive were recalled for possible reduction in effectiveness.
Read More
Prior Authorization Requirements for Calcitonin Gene-Related Peptide Antagonists
April 20th 2023This quantitative and qualitative analysis highlights differences in prior authorization requirements for migraine drugs from nearly 50 managed care organizations and summarizes broad types of criteria used.
Read More