Migraine Linked to Increased CVD Risk in Men

Susan Jeffrey

November 16, 2006

November 16, 2006 (Chicago) — A new report from the Physicians' Health Study suggests that — as this group recently showed in women — men with migraine face a higher risk for cardiovascular disease, particularly myocardial infarction (MI), over time.

In this cohort, men who reported a history of migraine had a significant 24% increase in risk for major CVD, driven primarily by a 42% increase in the risk for MI, Tobias Kurth, MD, ScD, from Brigham and Women's Hospital, in Boston, Massachusetts, told attendees here at the American Heart Association 2006 Scientific Sessions.

Similar Findings in Women

Migraine with aura has previously been associated with an adverse cardiovascular risk profile, including increased cholesterol or hypertension, Dr. Kurth said, as well as with inflammatory or prothrombotic factors that, combined with the physiology of migraine, may increase the risk for vascular events. There is also a link between migraine and a genetic polymorphism that increases homocysteine that could potentially increase CV disease.

In a paper published earlier this year, Dr. Kurth and colleagues reported a similar analysis using data from the Women's Health Study (Kurth T et al. JAMA 2006;296:283-291). They found that migraine with aura was associated with increased risk for major cardiovascular disease, MI, ischemic stroke, and death due to ischemic CVD, as well as with coronary revascularization and angina. Migraine without aura, though, was not associated with increased risk for any of these events.

In this study, the researchers used data from the Physicians' Health Study, a prospective cohort study of 20,084 men who were free of outcome events at the start of follow -up. The men replied to yearly questionnaires and were asked about migraines, risk factors, and whether or not any study end point occurred.

Men were considered migraineurs if they reported migraine during the first 60 months, after which follow-up for new CVD events began, Dr. Kurth noted. Of the total cohort, 1449 men, or 7.2%, reported migraine; 434 reported they had frequent migraines, defined as more than 4 reports of migraine during the initial study period.

Over 15.7 years of follow-up, 2236 major cardiovascular events occurred.

After adjustment for a variety of factors, they found a significantly increased risk for the development of major cardiovascular disease among migraineurs vs men without migraine, particularly an increased risk for MI. However, no significant increase in the risk for ischemic stroke, coronary revascularization, angina, or ischemic cardiovascular death was seen among those with migraine vs no migraine.

Multivariate adjusted risk for cardiovascular outcomes for men with migraine vs those without migraine

End Point
Hazard ratio
95% CI
P
Major CVD
1.24
1.06 — 1.46
.008
Ischemic stroke
1.12
0.84 — 1.50
.43
MI
1.42
1.15 — 1.77
< .001
Coronary revascularization
1.05
0.89 — 1.24
.54
Angina
1.15
0.99 — 1.33
.068
Ischemic cardiovascular death
1.07
0.80 — 1.43
.65

The magnitude of risk was largely similar for men who reported frequent migraines, although the hazard ratio for MI rose to about 1.52 (1.04 — 2.21).

Curves for the adjusted cumulative risk diverged between the groups by about 8 years and continued to diverge over the course of follow-up. Increased stroke risk associated with migraine was apparent, but only for the younger men, with the risk decreasing again over time. MI, on the other hand, showed an even steeper increase by the end of follow-up, a sort of "kick" that had also been seen with the women, Dr. Kurth told Medscape.

No data, however, were collected on aura in this group, so it is not possible to directly compare these findings with those from the Women's Health Study, where the increased risk for allevents considered — major cardiovascular disease, MI, ischemic stroke, and death due to ischemic CVD, as well as with coronary revascularization and angina — was seen only among those who had migraine with aura.

"Since this migraine-CVD association was apparent only from migraine with aura in women, this difference may be explained by the missing information on migraine with aura in men," Dr. Kurth said.

Asked by the session moderator about what doctors should do with this information, Dr. Kurth pointed out that "the attributable risk is fairly low, so people should certainly not panic." He suggested that physicians of patients with migraine who are concerned about their cardiovascular risk should focus instead on the modification or treatment of known major cardiovascular risk factors.

Future studies should look further at the mechanisms that might drive the association between migraine and cardiovascular risk, he noted.

AHA Scientific Sessions 2006: Abstract 4202.

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