But no explanation why. More research needed that will not occur in any reasonable amount of time. We need strong stroke leadership and a strategy, but have neither.
http://www.medpagetoday.com/Cardiology/CardioBrief/58237?xid=nl_mpt_DHE_2016-06-01&eun=g424561d0r
Women who have migraine headaches have a significantly increased risk of cardiovascular disease, according to new results from a large observational study published in The BMJ.
Earlier studies have established a strong link between migraine and
stroke, which the new study now extends to other types of cardiovascular
disease. However, the clinical implications are uncertain since there
is no definite mechanism to explain the association.
Researchers
analyzed data from more than 115,000 women followed for more than 20
years in the Nurses' Health Study II. More than 17,000 participants
reported a migraine diagnosis. Women who had migraines were more likely
to have other risk factors for cardiovascular disease, including
hypertension, hypercholesterolemia, family history, obesity, and history
of smoking.
After adjusting for the known risk factors, women with migraine had a
significantly elevated risk for developing major cardiovascular disease
(hazard ratio 1.50, 95% CI 1.33-1.69). The greatest increase in risk
was for stroke (HR 1.62) and for angina/coronary revascularizations (HR
1.73).
The findings were consistent and robust across multiple analyses. But
the authors acknowledged that, as with any observational study, cause
and effect could not be demonstrated and that residual confounding
factors might offer "a potential alternative explanation."
The chief weakness in the link between migraine and cardiovascular
disease is the lack of "clear mechanisms ... that could explain the
increased risk of cardiovascular disease," write the authors. There is
also no evidence looking at "whether prevention of migraine attacks
reduces these risks."
In an accompanying editorial, Rebecca Burch, MD, of Harvard Medical School, and Melissa Rayhill, MD,
of SUNY Buffalo, wrote that "it is time to add migraine to the list of
early life medical conditions that are markers for later life
cardiovascular risk." But, they warned, "the magnitude of the risk
should not be over-emphasized," because the increased risk "is small at
the level of the individual patient but still important at a population
level because migraine is so prevalent."
Burch
and Rayhill also warned against any attempt to use the association to
influence treatment. Without better evidence, they wrote, "migraine is
probably best thought of as a situation in which the medical urge to 'do
something' (beyond currently recommended assessments for cardiac risk
and advocating a healthy lifestyle) should be resisted."
Burch affirmed her position in an email interview. "There is
currently no evidence to recommend any changes in how physicians manage
cardiovascular risk in patients with a history of migraine. If a patient
has a history of migraine, it might remind the physician of the
importance of assessing cardiovascular risk in that patient. Once the
risk has been assessed, however, management would be the same: treatment
of hypertension and hyperlipidemia, recommending regular exercise,
etc."
The first author of the study, Tobias Kurth, MD, of
the Harvard T.H. Chan School of Public Health, agreed with the
editorialists and said that physicians "cannot really make any inference
of treatment" based on the association in the study. "Physicians may
want to discuss vascular risk with patients and reduce the risk by
addressing known vascular risk factors (i.e., where we know that
intervention helps)."
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