Over the last few years, there has been a great deal of discussion regarding Migraine disease and increased risk of stroke. There had not been, however, sufficient study of Migraine and cardiovascular disease (CVD) to either acknowledge or dismiss any connection between Migraine and CVD. Earlier this year (2006), information surfaced that provides compelling evidence of increased risk of cardiovascular disease in women over 45 with Migraine with aura. (See Migraine With Aura Linked To Cardiovascular Disease.)
 

Study objective

To evaluate the association between Migraine and risks of overall and specific CVD in a large prospective cohort of middle-aged men.
 

Study methods

• A prospective cohort study of 20,084 participating in the Physician’s Health Study
• The Physician’s Health Study
  • Completed trial of aspirin and beta carotene in the prevention of CVD and cancer among 22,071 apparently healthy men.
  • When they entered the study (1981-1984), men were ages 40 to 84 and free of CVD, cancer and other major illness.
  • At the beginning of the study, 6 months later, then annually, participants completed questionnaires to collect demographic and lifestyle information, as well as medical information for the time period.
  • Excluded: 1,987 men with missing Migraine information or who had CVD during the Migraine screening period.
• Establishing Migraine
  • On the 6-month and on annual questionnaires, participants were asked whether they have experienced a Migraine since the last questionnaire.
  • Since participants were not asked about any lifetime history of Migraine and to make the Migraine ascertainment more comparable to the study in women, men were classified as having Migraine if they indicated Migraine during the first 5 years of the study.
  • Frequent Migraine: if participants reported Migraine 4 or more times during the one-year period between questionnaires.
  • No information was collected about Migraine aura
• Establishing CVD
  • Myocardial infarction was confirmed if symptoms met WHO criteria and the event was associated with abnormal levels of cardiac enzymes or diagnostic electrocardiograms.
  • Nonfatal stroke was confirmed if the participant had a new focal-neurological deficit of sudden onset and vascular origin that persisted for more than 24 hours.
  • Cardiovascular deaths were confirmed by review of autopsy reports, death certificates, medical records, and information obtained from next of kin or family members.
     

Study results

• Of the 20,084 participants, a total of 1,449 (7%) men reported Migraine, and 434 reported Migraine 4 or more times.
• Compared to men who did not report Migraine, Migraineurs were:
  • Younger
  • Reported more often a history of hypertension
  • Were less Likely to currently smoke cigarettes and consume alcohol regularly
  • Were more likely to report a history of elevated cholesterol of 240mg/dL or higher.
• CVD events during follow-up:
  • 2,236 major CVD
  • 750 ischemic strokes
  • 1,046 myocardial infarctions
  • 866 ischemic CVD deaths
  • 2,257 coronary revascularizations
  • 2,625 reports of angina
• Risk of major cardiovascular events in men with Migraines was increased by 24% with myocardial infarction (heart attack) as the leading reported cardiovascular event. It's important, however, to realize that this 24% increase translates to just two major CVD events per 10,000 men per year.
   

Study conclusions

Kurth and his colleagues concluded,

"In this large prospective cohort of apparently healthy men, Migraine was associated with risk of major CVD, which was driven by an increased risk of myocardial infarction."

In his presentation to the American Heart Association, Kurth said,

"The attributable risk is fairly low, so I think people should certainly not panic if they have a Migraine attack that they’ll have a heart attack the next day. We know much more about major risk factors and we should certainly emphasize and modify those. At this point, there’s no data that would support to change any treatment of Migraine or anything else for Migraineurs at this point."
 

Summary

The results of this study were very similar to Kurth et al's study of Migraine and cardiovascular disease in women. As in the women's study, the exact mechanisms linking Migraine disease and CVD are unclear and unlikely to be simple. The correlation could be due to an increased cardiovascular risk profile, inflammatory issues, genetics, or a combination of these issues.

This study provides incentive for patients and physicians to be more vigilant about modifiable cardiovascular risk factors and for studies to determine if there are medications that can be used to prevent Migraine attacks and reduce CVD risk. If you have Migraine disease, this is a topic to discuss with your doctor as modifying your risk factors can help prevent cardiovascular problems.
 

_____________
Resources:

Kurth, Tobias, MD, ScD; Gaziano, J. Michael, MD, MPH; Cook, Nancy R., ScD; Bubes, Vadim, PhD; Logroscino, Giancarlo, MD, PhD; Diener, Hans-Christoph, MD, PhD; Buring, Julie E., ScD. (2006) "Migraine is Associated with Increased Risk of Cardiovascular Disease in Men." Platform presentation. American Heart Association Scientific Session. November 15, 2006, Chicago, Illinois.

HealthDay. "Migraines Linked to Heart Risk in Men." Medline Plus. November 15, 2006.

Physicians Health Study http://phs.bwh.harvard.edu/
 

© Teri Robert, November 30, 2006