Brigham and Women's Hospital, USA.
Cephalalgia. 2011 Jul;31(10):1106-15. doi: 10.1177/0333102411412628. Epub 2011 Jun 14.
Migraine with aura (MA) has been associated with increased risk of cardiovascular disease (CVD). The role of aspirin on this association remains unclear.
Post-hoc subgroup analyses of the Women's Health Study, a randomized trial testing 100 mg aspirin on alternate days in primary prevention of CVD among 39,876 women aged ≥ 45.
During 10 years, 998 major CVD events were confirmed in 39,757 women with complete migraine information. Aspirin reduced risk of ischaemic stroke (relative risk, RR, 0.76, 95% CI 0.63-0.93) but not other CVD. Migraine or MA did not modify the effect of aspirin on CVD except for myocardial infarction (MI) (p for interaction = 0.01). Women with MA on aspirin had increased risk of MI (RR 3.72, 95% CI 1.39-9.95). Further exploratory analyses indicate that this increased risk is only apparent among women with MA on aspirin who ever smoked or had history of hypertension (p for interaction<0.01).
In post-hoc subgroup analyses, aspirin had similar protective effects on ischaemic stroke for women with or without migraine. By contrast, our data suggest that women with MA on aspirin had increased risk of MI. The small number of outcome events in subgroups, the exploratory nature of our analyses, and lack of plausible mechanisms raise the possibility of a chance finding, which must caution the interpretation.
有先兆偏头痛（MA）与心血管疾病（CVD）风险增加相关。阿司匹林在这种关联中的作用仍不清楚。
对 Women's Health Study 的事后亚组分析，这是一项随机试验，在 39876 名年龄≥45 岁的 CVD 一级预防中测试隔日服用 100mg 阿司匹林。
在 10 年期间，在有完整偏头痛信息的 39757 名女性中，有 998 例主要 CVD 事件得到证实。阿司匹林降低缺血性中风的风险（相对风险，RR，0.76，95%CI 0.63-0.93），但不降低其他 CVD。偏头痛或 MA 并没有改变阿司匹林对 CVD 的影响，除了心肌梗死（MI）（交互作用的 p 值=0.01）。服用阿司匹林的 MA 女性发生 MI 的风险增加（RR 3.72，95%CI 1.39-9.95）。进一步的探索性分析表明，这种风险增加仅出现在曾吸烟或有高血压史的服用阿司匹林的 MA 女性中（交互作用的 p 值<0.01）。
在事后亚组分析中，阿司匹林对有或没有偏头痛的女性的缺血性中风具有相似的保护作用。相比之下，我们的数据表明，服用阿司匹林的 MA 女性发生 MI 的风险增加。亚组中结局事件的数量较少，我们分析的探索性质以及缺乏合理的机制增加了偶然发现的可能性，这必须引起对解释的警惕。
