{"id":1085,"date":"2016-07-01T15:00:22","date_gmt":"2016-07-01T15:00:22","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=1085"},"modified":"2017-08-21T10:52:01","modified_gmt":"2017-08-21T10:52:01","slug":"primary-care-corner-with-geoffrey-modest-md-migraine-and-heart-disease-in-women","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2016\/07\/01\/primary-care-corner-with-geoffrey-modest-md-migraine-and-heart-disease-in-women\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: Migraine and Heart Disease in Women"},"content":{"rendered":"<p><strong>By Dr. Geoffrey Modest<\/strong><\/p>\n<p>Analysis of the Nurses&#8217; Health Study found\u00a0a significant increase in cardiovascular disease in those with migraine<\/p>\n<p>(see\u00a0<a href=\"http:\/\/dx.doi.org\/10.1136\/bmj.i2610\">http:\/\/dx.doi.org\/10.1136\/bmj.i2610<\/a> ).<\/p>\n<p>Details:<\/p>\n<ul>\n<li>115 541 women aged 25-42 years at baseline and free of angina and cardiovascular disease were followed\u00a0from the prospective Nurses&#8217; Health Study II\u00a0(from 1989-2011)<\/li>\n<li>Mean age 35; BMI &lt;25 in 68%,\u00a025-30 in 19%; history hypertension 6%, hypercholesterolemia 12%, smoking 14%; no\u00a0alcohol in 38%, up to\u00a015 g\/d in 58%; oral contraceptives in 12%.<\/li>\n<li>17 531 (15.2%) women reported a physician\u2019s diagnosis of migraine (though no data on presence of aura, migraine frequency, or migraine meds)<\/li>\n<li>Women with migraine were more likely to have hypertension, hypercholesterolemia, family history of MI, BMI&gt;30 or be current smoker<\/li>\n<\/ul>\n<p>Results:<\/p>\n<ul>\n<li>1329 major cardiovascular disease events occurred, and 223 women died from cardiovascular disease<\/li>\n<li>Adjusting\u00a0for potential confounding factors (age, cholesterol, diabetes, hypertension, BMI, smoking, alcohol, physical activity, postmenopausal estrogens, menopausal status, oral contraceptives, aspirin\/acetaminophen\/NSAID use, and family history MI), migraine was associated with an increased risk for:\n<ul>\n<li>Major cardiovascular disease (hazard ratio1.50, 95% confidence interval 1.33 to 1.69)<\/li>\n<li>Myocardial infarction (HR\u00a01.39, 1.18 to 1.64)<\/li>\n<li>Stroke (HR\u00a01.62, 1.37 to 1.92)<\/li>\n<li>Angina\/coronary revascularization procedures (HR\u00a01.73, 1.29 to 2.32)<\/li>\n<li>Cardiovascular disease mortality (HR 1.37, 1.02 to 1.83)<\/li>\n<li>Associations were similar across subgroups of women, including by\u00a0age (&lt;50\/\u226550), smoking status (current\/past\/never), hypertension (yes\/no), postmenopausal hormone therapy (current\/not current), and oral contraceptive use (current\/not current)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>Commentary:<\/p>\n<ul>\n<li>Several studies have found that migraine (specifically migraine with aura) is associated with increased risk of stroke<\/li>\n<li>The Women&#8217;s Health Initiative found similar increase\u00a0in cardiovascular disease (about the same +\/- 50% increase as above), but only in those reporting migraine with aura<\/li>\n<li>Several other studies from different countries (Taiwan, Iceland, as well as the American Migraine Prevalence and Prevention Study)\u00a0have found similar results<\/li>\n<li>How to explain the association?? Unclear. ?increased thrombogenic susceptibility, shared genetic markers, endothelial dysfunction, or\u00a0inflammation (all have been shown in both migraine and cardiovascular disease). And a recent small study found that the combination of a statin and vitamin D, perhaps through their anti-inflammatory or endothelial\u00a0effects, decreased the frequency of migraines (for analysis of this study, see prior blog:\u00a0<a href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2016\/01\/06\/primary-care-corner-with-geoffrey-modest-md-migraine-prophylaxis-with-simvastatinvitamin-d\">https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2016\/01\/06\/primary-care-corner-with-geoffrey-modest-md-migraine-prophylaxis-with-simvastatinvitamin-d<\/a><\/li>\n<li>So, it probably makes sense to include migraine (perhaps more so if aura present) in the overall gestalt of cardiovascular risk factors \u2013 e., it would be an added reason to strongly encourage lifestyle changes (smoking, appropriate\u00a0weight, increasing fruits\/veges in diet, exercise) in general, and it might sway me to use statins in those otherwise\u00a0on the borderline for medical therapy<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Primary Care Corner with Geoffrey Modest MD: Migraine and Heart Disease in Women  [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2016\/07\/01\/primary-care-corner-with-geoffrey-modest-md-migraine-and-heart-disease-in-women\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":148,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[14283],"tags":[],"class_list":["post-1085","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/1085","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=1085"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/1085\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=1085"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=1085"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=1085"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}