Increased risk of ischemic heart disease in young patients with migraine: A population-based, propensity score-matched, longitudinal follow-up study

doi:10.1016/j.ijcard.2014.01.005

International Journal of Cardiology

Volume 172, Issue 1, 1 March 2014, Pages 213-216

https://doi.org/10.1016/j.ijcard.2014.01.005 Get rights and content

Abstract

Background

The association between migraine and the risk of ischemic heart disease (IHD) remains controversial. The purpose of the present population-based, propensity score-matched follow-up study was to investigate whether young migraineurs are at a higher risk of developing IHD.

Methods

A total of 11,541 subjects aged between 18 and 45 years with at least two ambulatory visits with the principal diagnosis of migraine in 2001 were enrolled in the migraine group. We used a logistic regression model that included age, sex, pre-existing comorbidities, and socioeconomic status as covariates to compute the propensity score. The non-migraine group consisted of 11,541 propensity score-matched, randomly sampled subjects without migraine. The 3-year IHD-free survival rate and the cumulative incidence of IHD were estimated using the Kaplan–Meier method. Stratified Cox proportional hazard regression with patients matched by propensity score was used to estimate the effect of migraine on the risk of developing subsequent IHD.

Results

The mean age in both groups was 32.3 years. During follow-up, 121 subjects in the migraine group and 55 in the non-migraine group developed IHD. The incidence rate of IHD was 4.56 (95% confidence interval [CI], 3.78 to 5.44) per 1000 person-years in the migraine group and 2.00 (95% CI, 1.51 to 2.61) per 1000 person-years in the non-migraine group. Compared to the non-migraine group, the HR of IHD for the migraine group was 2.50 (95% CI, 1.78 to 3.52, P < 0.0001).

Conclusions

This study showed an increased risk of developing IHD in young patients with newly diagnosed migraine.

Introduction

Migraine, a common incapacitating neurovascular headache, can occur at any age, but the incidence peaks in early- to mid-adolescence [1]. Migraine has been associated with an increased risk of vascular disorder [2], [3]. Epidemiological studies have shown an increased risk of ischemic stroke in migraineurs [4], [5], [6], and the risk of ischemic stroke appears to be greater at a younger age [7]. However, the relationship between migraine and ischemic heart disease (IHD) remains controversial. One cohort study on male physicians aged 40 or older found that migraine was associated with an increased risk of myocardial infarction [8], and a cohort study on women aged over 45 found that migraines with aura had a higher risk of IHD [4]. However, other studies failed to demonstrate any association between migraine and IHD [9], [10], [11]. In addition, most of these studies were conducted in a selected population and the participants were middle-aged or older. While migraine is primarily a headache disorder that usually develops in the young population, few studies have focused on young migraineurs and the corresponding IHD risk. Elucidating the IHD risk in young migraineurs would be informative for clinical risk assessment. The purpose of this population-based, propensity score-matched longitudinal follow-up study was therefore to investigate whether young migraineurs are at a higher risk of IHD.

Section snippets

Data source

The data used in this study were obtained from the complete National Health Insurance (NHI) claim database in Taiwan for the period 2000 to 2003. The NHI program has been implemented in Taiwan since 1995, and the coverage rate was 96% of the whole population in 2000 and 97% at the end of 2003, i.e. more than 21.9 million persons. It should be noted that the rationale for using the NHI database after 2000 is that, from Jan 1st, 2000, according to the rules of the Bureau of NHI, the NHI claim data

Results

Table 1 shows the demographic and clinical characteristics of the migraine and non-migraine groups before propensity score matching. The migraine group had a higher prevalence of certain pre-existing medical comorbidities, including hypertension (P < 0.0001), dyslipidemia (P < 0.0001), renal disease (P < 0.0001), and stroke (P < 0.0001), than the non-migraine group. There were also significant differences in the distribution of monthly income, urbanization level, and geographic region between the two

Discussion

In the present population-based, propensity score-matched, longitudinal follow-up study, we found that young migraineurs had a 2.5-fold higher risk of IHD than non-migrainers (HR 2.50; 95% CI 1.78 to 3.52). Although previous epidemiological studies have shown a positive association between migraine and IHD [4], [5], [6], [8], [21], most of these were conducted on middle-aged or older population. Since onset of migraine occurs typically in mid-adolescence, our study showing an increased risk of

Funding

This work was supported by grants DOH93-TD-M-113-030, DOH94-TD-M-113-004, and DOH95-TD-M-113-002 from the Department of Health, Executive Yuan, Republic of China.

This study used the complete National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health. The findings and conclusions in our study are not necessarily those of the Department of Health, Executive Yuan, Republic of China.

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Citation Excerpt :
There are conflicting data regarding an association between migraine and myocardial infarction. A meta-analysis from 2009 did not find an increased risk between myocardial infarction and any migraine compared with no migraine,75 but later studies report an association between migraine and cardiac ischaemic disease,72,82 and between myocardial infarction and migraine either with or without aura in both sexes.71 A meta-analysis of observational studies up to April, 2014, indicated an increased risk of myocardial infarction (pooled adjusted effect estimate 1·33, 95% CI 1·08–1·64, p=0·007) in people with migraine compared with people without migraine, driven by the increased risk in those with migraine with aura.83
Migraine is two to three times more prevalent in women than men, and women report a longer attack duration, increased risk of headache recurrence, greater disability, and a longer period of time required to recover. Conditions recognised to be comorbid with migraine include asthma, anxiety, depression, and other chronic pain conditions, and these comorbidities add to the amount of disability in both sexes. Migraine—specifically migraine with aura—has been identified as a risk factor for vascular disorders, particularly in women, but because of the scarcity of data, the comparative risk in men has yet to be established. There is evidence implicating the role of female sex hormones as a major factor in determining migraine risk and characteristics, which accounts for sex differences, but there is also evidence to support underlying genetic variance. Although migraine is often recognised in women, it is underdiagnosed in men, resulting in suboptimal management and less participation of men in clinical trials.
Recent advance in relationship between migraine and cardiovascular diseases
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Association between migraine and cardiovascular disease: A cross-sectional study
2022, Frontiers in Cardiovascular Medicine
Increased Risk of Cardio-Cerebrovascular Diseases in Migraine Patients: A Nationwide Population-Based, Longitudinal Follow-Up Study in South Korea
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¹: Takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

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Increased risk of ischemic heart disease in young patients with migraine: A population-based, propensity score-matched, longitudinal follow-up study

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

Data source

Results

Discussion

Funding

J Clin Epidemiol

Clin Biochem

Pediatr Neurol

Migraine—current understanding and treatment

N Engl J Med

Cardiovascular risk factors and migraine: the GEM population-based study

Neurology

Migraine and vascular diseases: a review of the evidence and potential implications for management

Cephalalgia

Migraine and risk of cardiovascular disease in women

JAMA

Migraine frequency and risk of cardiovascular disease in women

Neurology

Migraine with aura and risk of cardiovascular and all cause mortality in men and women: prospective cohort study

BMJ

Migraine and cardiovascular disease: systematic review and meta-analysis

BMJ

Migraine and risk of cardiovascular disease in men

Arch Intern Med

Triptans in migraine: the risks of stroke, cardiovascular disease, and death in practice

Neurology

Relationship of migraine headaches to experience of chest pain and subsequent risk for myocardial infarction

Neurology

Migraine and coronary heart disease mortality: a prospective cohort study

Cephalalgia

Performing a 1:N case–control match on propensity score. Proceedings of the 29th Annual SAS Users Group International Conference

Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group

Stat Med

Urbanization and stroke prevalence in Taiwan: analysis of a nationwide survey

J Urban Health

Geographic distribution of stroke incidence within an urban population: relations to socioeconomic circumstances and prevalence of cardiovascular risk factors

Stroke