Kurth Tobias, Winter Anke C, Eliassen A Heather, Dushkes Rimma, Mukamal Kenneth J, Rimm Eric B, Willett Walter C, Manson JoAnn E, Rexrode Kathryn M
Institute of Public Health, Charité - Universitätsmedizin, D-10117 Berlin, Germany Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA.
BMJ. 2016 May 31;353:i2610. doi: 10.1136/bmj.i2610.
To evaluate the association between migraine and incident cardiovascular disease and cardiovascular mortality in women.
Prospective cohort study among Nurses' Health Study II participants, with follow-up from 1989 and through June 2011.
Cohort of female nurses in United States.
115 541 women aged 25-42 years at baseline and free of angina and cardiovascular disease. Cumulative follow-up rates were more than 90%.
The primary outcome of the study was major cardiovascular disease, a combined endpoint of myocardial infarction, stroke, or fatal cardiovascular disease. Secondary outcome measures included individual endpoints of myocardial infarction, stroke, angina/coronary revascularization procedures, and cardiovascular mortality.
17 531 (15.2%) women reported a physician's diagnosis of migraine. Over 20 years of follow-up, 1329 major cardiovascular disease events occurred and 223 women died from cardiovascular disease. After adjustment for potential confounding factors, migraine was associated with an increased risk for major cardiovascular disease (hazard ratio 1.50, 95% confidence interval 1.33 to 1.69), myocardial infarction (1.39, 1.18 to 1.64), stroke (1.62, 1.37 to 1.92), and angina/coronary revascularization procedures (1.73, 1.29 to 2.32), compared with women without migraine. Furthermore, migraine was associated with a significantly increased risk for cardiovascular disease mortality (hazard ratio 1.37, 1.02 to 1.83). Associations were similar across subgroups of women, including by age (<50/≥50), smoking status (current/past/never), hypertension (yes/no), postmenopausal hormone therapy (current/not current), and oral contraceptive use (current/not current).
Results of this large, prospective cohort study in women with more than 20 years of follow-up indicate a consistent link between migraine and cardiovascular disease events, including cardiovascular mortality. Women with migraine should be evaluated for their vascular risk. Future targeted research is warranted to identify preventive strategies to reduce the risk of future cardiovascular disease among patients with migraine.
评估女性偏头痛与心血管疾病发病及心血管疾病死亡率之间的关联。
对护士健康研究II参与者进行前瞻性队列研究，随访时间从1989年至2011年6月。
美国女性护士队列。
115541名年龄在25 - 42岁之间、基线时无心绞痛和心血管疾病的女性。累积随访率超过90%。
研究的主要结局是重大心血管疾病，这是一个由心肌梗死、中风或致命心血管疾病组成的复合终点。次要观察指标包括心肌梗死、中风、心绞痛/冠状动脉血运重建术的单独终点以及心血管疾病死亡率。
17531名（15.2%）女性报告医生诊断为偏头痛。在超过20年的随访中，发生了1329例重大心血管疾病事件，223名女性死于心血管疾病。在对潜在混杂因素进行调整后，与无偏头痛的女性相比，偏头痛与重大心血管疾病风险增加相关（风险比1.50，95%置信区间1.33至1.69）、心肌梗死（1.39，1.18至1.64）、中风（1.62，1.37至1.92）以及心绞痛/冠状动脉血运重建术（1.73，1.29至2.32）。此外，偏头痛与心血管疾病死亡率显著增加相关（风险比1.37，1.02至1.83）。在不同亚组女性中，包括年龄（<50/≥50岁）、吸烟状况（当前/过去/从不）、高血压（是/否）、绝经后激素治疗（当前/非当前）以及口服避孕药使用情况（当前/非当前），关联相似。
这项对女性进行的超过20年随访的大型前瞻性队列研究结果表明，偏头痛与心血管疾病事件（包括心血管疾病死亡率）之间存在持续的关联。患有偏头痛的女性应评估其血管风险。未来有必要进行针对性研究，以确定预防策略，降低偏头痛患者未来患心血管疾病的风险。
