老年人偏头痛和偏头痛药物与缺血性中风和冠心病的风险。
Risk for ischemic stroke and coronary heart disease associated with migraine and migraine medication among older adults.
机构信息
Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd, RPHB 523B, Birmingham, AL, 35233-0013, USA.
Centre for Headache, University of Toronto, Toronto, ON, Canada.
出版信息
J Headache Pain. 2021 Oct 13;22(1):124. doi: 10.1186/s10194-021-01338-z.
BACKGROUND
Migraine has been associated with cardiovascular disease (CVD) events among middle-aged adults. The objective of this study was to determine the risk for ischemic stroke and coronary heart disease (CHD) events among older adults with versus without migraine.
METHODS
This retrospective cohort study was conducted using data from US adults ≥66 years of age with Medicare health insurance between 2008 and 2017. After stratification by history of CVD, patients with a history of migraine were matched 1:4 to those without a history of migraine, based on calendar year, age, and sex. Patients were followed through December 31, 2017 for ischemic stroke and CHD events including myocardial infarction or coronary revascularization. All analyses were done separately for patients with and without a history of CVD.
RESULTS
Among patients without a history of CVD (n = 109,950 including n = 21,990 with migraine and n = 87,960 without migraine), 1789 had an ischemic stroke and 3552 had a CHD event. The adjusted hazard ratio (HR) among patients with versus without migraine was 1.20 (95% confidence interval [95%CI], 1.07-1.35) for ischemic stroke and 1.02 (95%CI, 0.93-1.11) for CHD events. Compared to patients without migraine, those with migraine who were taking an opioid medication had a higher risk for ischemic stroke (adjusted HR 1.43 [95%CI, 1.20-1.69]), while those taking a triptan had a lower risk for CHD events (adjusted HR 0.79 [95%CI, 0.67-0.93]). Among patients with a history of CVD (n = 79,515 including n = 15,903 with migraine and n = 63,612 without migraine), 2960 had an ischemic stroke and 7981 had a CHD event. The adjusted HRs (95%CI) for ischemic stroke and CHD events associated with migraine were 1.27 (1.17-1.39) and 0.99 (0.93-1.05), respectively. Patients with migraine taking an opioid medication had a higher risk for ischemic stroke (adjusted HR 1.21 [95%CI, 1.07-1.36]), while those taking a triptan had a lower risk for CHD events (adjusted HR 0.83 [95%CI, 0.72-0.95]), each versus those without migraine.
CONCLUSIONS
Older adults with migraine are at increased risk for ischemic stroke. The risk for ischemic stroke among older adults with migraine may differ by migraine medication classes.
背景
偏头痛与中年成年人的心血管疾病 (CVD) 事件有关。本研究的目的是确定有偏头痛和无偏头痛的老年患者发生缺血性卒中和冠心病 (CHD) 事件的风险。
方法
本回顾性队列研究使用了 2008 年至 2017 年期间参加美国老年人医疗保险计划且年龄在 66 岁及以上的成年人的数据。根据 CVD 病史进行分层后，将有偏头痛病史的患者按年份、年龄和性别与无偏头痛病史的患者 1:4 匹配。通过 2017 年 12 月 31 日对缺血性卒中和 CHD 事件（包括心肌梗死或冠状动脉血运重建）进行随访。所有分析均分别针对有和无 CVD 病史的患者进行。
结果
在无 CVD 病史的患者中（n=109950，包括偏头痛患者 n=21990 例，无偏头痛患者 n=87960 例），有 1789 例发生缺血性卒中和 3552 例发生 CHD 事件。有偏头痛和无偏头痛的患者相比，调整后的 HR 分别为缺血性卒中和 CHD 事件为 1.20（95%置信区间[95%CI]，1.07-1.35）和 1.02（95%CI，0.93-1.11）。与无偏头痛的患者相比，服用阿片类药物的偏头痛患者发生缺血性卒中的风险更高（调整后的 HR 1.43[95%CI，1.20-1.69]），而服用曲坦类药物的患者发生 CHD 事件的风险更低（调整后的 HR 0.79[95%CI，0.67-0.93]）。在有 CVD 病史的患者中（n=79515，包括偏头痛患者 n=15903 例，无偏头痛患者 n=63612 例），有 2960 例发生缺血性卒中和 7981 例发生 CHD 事件。偏头痛与缺血性卒中和 CHD 事件相关的调整后 HR（95%CI）分别为 1.27（1.17-1.39）和 0.99（0.93-1.05）。服用阿片类药物的偏头痛患者发生缺血性卒中的风险更高（调整后的 HR 1.21[95%CI，1.07-1.36]），而服用曲坦类药物的患者发生 CHD 事件的风险更低（调整后的 HR 0.83[95%CI，0.72-0.95]），与无偏头痛的患者相比。
结论
偏头痛的老年患者发生缺血性卒中和 CHD 的风险增加。偏头痛患者发生缺血性卒中的风险可能因偏头痛药物类别而异。
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