Migraine and risk of cardiovascular diseases: Danish population based matched cohort study

TY - JOUR

T1 - Migraine and risk of cardiovascular diseases

T2 - Danish population based matched cohort study

AU - Adelborg, Kasper

AU - Szépligeti, Szimonetta Komjáthiné

AU - Holland-Bill, Louise

AU - Ehrenstein, Vera

AU - Horváth-Puhó, Erzsébet

AU - Henderson, Victor W

AU - Sørensen, Henrik Toft

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

PY - 2018/1/31

Y1 - 2018/1/31

N2 - OBJECTIVE: To examine the risks of myocardial infarction, stroke (ischaemic and haemorrhagic), peripheral artery disease, venous thromboembolism, atrial fibrillation or atrial flutter, and heart failure in patients with migraine and in a general population comparison cohort.DESIGN: Nationwide, population based cohort study.SETTING: All Danish hospitals and hospital outpatient clinics from 1995 to 2013.PARTICIPANTS: 51 032 patients with migraine and 510 320 people from the general population matched on age, sex, and calendar year.MAIN OUTCOME MEASURES: Comorbidity adjusted hazard ratios of cardiovascular outcomes based on Cox regression analysis.RESULTS: Higher absolute risks were observed among patients with incident migraine than in the general population across most outcomes and follow-up periods. After 19 years of follow-up, the cumulative incidences per 1000 people for the migraine cohort compared with the general population were 25v17 for myocardial infarction, 45v25 for ischaemic stroke, 11v6 for haemorrhagic stroke, 13v11 for peripheral artery disease, 27v18 for venous thromboembolism, 47v34 for atrial fibrillation or atrial flutter, and 19v18 for heart failure. Correspondingly, migraine was positively associated with myocardial infarction (adjusted hazard ratio 1.49, 95% confidence interval 1.36 to 1.64), ischaemic stroke (2.26, 2.11 to 2.41), and haemorrhagic stroke (1.94, 1.68 to 2.23), as well as venous thromboembolism (1.59, 1.45 to 1.74) and atrial fibrillation or atrial flutter (1.25, 1.16 to 1.36). No meaningful association was found with peripheral artery disease (adjusted hazard ratio 1.12, 0.96 to 1.30) or heart failure (1.04, 0.93 to 1.16). The associations, particularly for stroke outcomes, were stronger during the short term (0-1 years) after diagnosis than the long term (up to 19 years), in patients with aura than in those without aura, and in women than in men. In a subcohort of patients, the associations persisted after additional multivariable adjustment for body mass index and smoking.CONCLUSIONS: Migraine was associated with increased risks of myocardial infarction, ischaemic stroke, haemorrhagic stroke, venous thromboembolism, and atrial fibrillation or atrial flutter. Migraine may be an important risk factor for most cardiovascular diseases.

AB - OBJECTIVE: To examine the risks of myocardial infarction, stroke (ischaemic and haemorrhagic), peripheral artery disease, venous thromboembolism, atrial fibrillation or atrial flutter, and heart failure in patients with migraine and in a general population comparison cohort.DESIGN: Nationwide, population based cohort study.SETTING: All Danish hospitals and hospital outpatient clinics from 1995 to 2013.PARTICIPANTS: 51 032 patients with migraine and 510 320 people from the general population matched on age, sex, and calendar year.MAIN OUTCOME MEASURES: Comorbidity adjusted hazard ratios of cardiovascular outcomes based on Cox regression analysis.RESULTS: Higher absolute risks were observed among patients with incident migraine than in the general population across most outcomes and follow-up periods. After 19 years of follow-up, the cumulative incidences per 1000 people for the migraine cohort compared with the general population were 25v17 for myocardial infarction, 45v25 for ischaemic stroke, 11v6 for haemorrhagic stroke, 13v11 for peripheral artery disease, 27v18 for venous thromboembolism, 47v34 for atrial fibrillation or atrial flutter, and 19v18 for heart failure. Correspondingly, migraine was positively associated with myocardial infarction (adjusted hazard ratio 1.49, 95% confidence interval 1.36 to 1.64), ischaemic stroke (2.26, 2.11 to 2.41), and haemorrhagic stroke (1.94, 1.68 to 2.23), as well as venous thromboembolism (1.59, 1.45 to 1.74) and atrial fibrillation or atrial flutter (1.25, 1.16 to 1.36). No meaningful association was found with peripheral artery disease (adjusted hazard ratio 1.12, 0.96 to 1.30) or heart failure (1.04, 0.93 to 1.16). The associations, particularly for stroke outcomes, were stronger during the short term (0-1 years) after diagnosis than the long term (up to 19 years), in patients with aura than in those without aura, and in women than in men. In a subcohort of patients, the associations persisted after additional multivariable adjustment for body mass index and smoking.CONCLUSIONS: Migraine was associated with increased risks of myocardial infarction, ischaemic stroke, haemorrhagic stroke, venous thromboembolism, and atrial fibrillation or atrial flutter. Migraine may be an important risk factor for most cardiovascular diseases.

KW - Adult

KW - Atrial Fibrillation/epidemiology

KW - Body Mass Index

KW - Cardiovascular Diseases/epidemiology

KW - Cohort Studies

KW - Comorbidity

KW - Denmark/epidemiology

KW - Female

KW - Heart Failure/epidemiology

KW - Humans

KW - Incidence

KW - Intracranial Hemorrhages/epidemiology

KW - Male

KW - Middle Aged

KW - Migraine Disorders/complications

KW - Myocardial Infarction/epidemiology

KW - Outcome Assessment (Health Care)

KW - Peripheral Arterial Disease/epidemiology

KW - Prospective Studies

KW - Risk Factors

KW - Smoking/epidemiology

KW - Stroke/epidemiology

KW - Venous Thromboembolism/epidemiology

UR - http://www.scopus.com/inward/record.url?scp=85042744452&partnerID=8YFLogxK

U2 - 10.1136/bmj.k96

DO - 10.1136/bmj.k96

M3 - Journal article

C2 - 29386181

SN - 0959-8146

VL - 360

SP - k96

JO - B M J

JF - B M J

M1 - k96

ER -