偏头痛和妊娠期糖尿病对早发性心肌梗死和中风长期风险的综合影响：一项基于人群的队列研究。
The combined impact of migraine and gestational diabetes on long-term risk of premature myocardial infarction and stroke: A population-based cohort study.
机构信息
Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark.
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
出版信息
Headache. 2024 Oct;64(9):1124-1134. doi: 10.1111/head.14821. Epub 2024 Aug 28.
OBJECTIVE
To examine the combined impact of migraine and gestational diabetes mellitus (GDM) on the risks of premature (persons aged ≤60 years) major adverse cardiovascular and cerebrovascular events (MACCE) based on a composite endpoint of fatal and non-fatal myocardial infarction (MI) and stroke.
BACKGROUND
Migraine and GDM are risk factors for cardiovascular disease. It is unknown how the combination of migraine and GDM may affect cardiovascular disease risk.
METHODS
In a Danish population-based cohort longitudinal study, we established four cohorts among women with at least one pregnancy during 1996-2018: women with migraine, women with GDM, women with both migraine and GDM, and women free of migraine and free of GDM. Risks of premature MACCE and component endpoints were assessed for each cohort.
RESULTS
We included 1,307,456 women free of migraine and free of GDM, 56,811 women with migraine, 24,700 women with GDM, and 1484 women with migraine and GDM. The 20-year absolute risk of MACCE was 1.3% (MI: 0.4%, ischemic stroke: 0.6%, hemorrhagic stroke: 0.3%) among women free of migraine and free of GDM, 2.3% (MI: 0.8%, ischemic stroke: 1.2%, hemorrhagic stroke: 0.5%) among women with migraine, 2.2% (MI: 1.0%, ischemic stroke: 1.0%, hemorrhagic stroke: 0.4%) among women with GDM, and 3.7% (MI: 1.7%, ischemic stroke: 1.7%, hemorrhagic stroke: 0.3%) among women with both migraine and GDM. The 20-year adjusted hazard ratio of premature MACCE was 1.65 (95% confidence interval [CI] 1.49-1.82) for women with migraine; 1.64 (95% CI 1.37-1.96) for women with GDM; and 2.35 (95% CI 1.03-5.36) for women with both GDM and migraine when compared with women free of migraine and free of GDM.
CONCLUSIONS
Migraine and GDM were each independently associated with an increased risk of MACCE. Risk of premature MACCE was greatest among women with both migraine and GDM, although this risk estimate was imprecise.
目的
基于致命和非致命性心肌梗死（MI）和卒中的复合终点，研究偏头痛和妊娠糖尿病（GDM）对早产（年龄≤60 岁）主要不良心脑血管事件（MACCE）风险的综合影响。
背景
偏头痛和 GDM 是心血管疾病的危险因素。尚不清楚偏头痛和 GDM 的组合如何影响心血管疾病的风险。
方法
在一项丹麦基于人群的队列纵向研究中，我们在 1996-2018 年期间建立了四个女性队列：偏头痛女性、GDM 女性、同时患有偏头痛和 GDM 的女性，以及无偏头痛和 GDM 的女性。评估了每个队列发生早产 MACCE 和各组成部分终点的风险。
结果
我们纳入了 1307456 名无偏头痛和无 GDM 的女性、56811 名偏头痛女性、24700 名 GDM 女性和 1484 名同时患有偏头痛和 GDM 的女性。无偏头痛和无 GDM 的女性 20 年 MACCE 的绝对风险为 1.3%（MI：0.4%，缺血性卒中：0.6%，出血性卒中：0.3%），偏头痛女性为 2.3%（MI：0.8%，缺血性卒中：1.2%，出血性卒中：0.5%），GDM 女性为 2.2%（MI：1.0%，缺血性卒中：1.0%，出血性卒中：0.4%），同时患有偏头痛和 GDM 的女性为 3.7%（MI：1.7%，缺血性卒中：1.7%，出血性卒中：0.3%）。偏头痛女性的早产 MACCE 20 年调整后的危险比为 1.65（95%置信区间 [CI]：1.49-1.82）；GDM 女性为 1.64（95% CI：1.37-1.96）；同时患有 GDM 和偏头痛的女性为 2.35（95% CI：1.03-5.36），与无偏头痛和无 GDM 的女性相比。
结论
偏头痛和 GDM 均与 MACCE 风险增加独立相关。同时患有偏头痛和 GDM 的女性发生早产 MACCE 的风险最高，尽管该风险估计不太准确。
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