Stroke and cardiovascular risk factors among working-aged Finnish migraineurs

DOI: https://doi.org/10.1186/s12889- 021- 11006- 1

Abstract-Summary The aim of our study was to evaluate the risk for comorbid cardio- and cerebrovas- cular diseases in the working-aged migraine population of Finland.

A total of 1505 cases who reported diagnosed migraine and 3010 controls from a cohort of 11,596 cases in the Finnish Health and Social Support Study were included.

ICD diagnoses I63 for ischemic stroke (IS), I21 − I22 for acute myocardial infarction (AMI), and G43 for transient ischemic attack (TIA) among study partici- pants were drawn from the national Finnish Care Register for Health Care at the follow-up in 2012.

The self-reported vascular risk factors were hypertension, high cholesterol val-

ues, any diabetes, myocardial infarction, stroke, and TIA.

A self-reported hypertension (21%), high serum cholesterol (38%), and any dia-

betes (7%) were more common among migraineurs vs controls (p < 0.05).

The risk for TIA (OR 3.20, 95% CI 1.45–7.05) and IS (2.57, 95% CI 1.28–5.17) among migraineurs vs controls remained high after adjustment for self-reported hypertension, obesity, and smoking.

The risk was higher among women in two groups ≥54 years (3.25, 95% CI

1.35–7.84 and 5.0, 95% CI 1.94–12.89, respectively).

The average age for IS in migraine was 57.5 years and for TIA 58.2 years among

women, and 52.8 years and 50.3 years among men, respectively.

Cardiovascular risk should be screened in the aging migraine population, and hormonal and other migraine-related risk factors should be considered, especially among women.

2.3 Comorbidities

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Extended: A total of 25,691 (99.2%) responded to the question on migraine in 1998, and up 11,596 had responded to the question on migraine in all three questionnaires.

The risk for myocardial infarction was not increased among migraineurs in con-

trast to another study [439].

The average age at diagnosed TIA was lower among migraineurs compared to

the controls (56.4 vs 58.7 years, p = 0.004).

Background A combination of attacks with aura (MA) or without aura (MO) at varying fre- quency may occur, and the changing vascular risk factors during the lifespan chal- lenge the assessment of the migraine-related risk for comorbidities, such as vascular diseases, in long-term studies [440].

Population-based and prospective studies have consistently reported an increased risk of ischemic stroke and cardiovascular disease in patients with overall migraine [441].

Understanding of cardio- and cerebrovascular risk in migraine has become more precise over the last decades, pointing at MA, female gender, and other independent risk factors [442–444].

The connection between migraine, stroke, and other cardiovascular diseases relates also to higher cardiovascular risk factors in migraineurs than in people with- out migraine [445].

The aim of our study was to evaluate the risk for comorbid cardio- and cerebro- vascular diseases and related self-reported risk factors in the working aged migraineur population in Finland.

Methods The control group from the same data pool consisted of two age- and sex-matched controls for every migraine patient among those who had responded negatively to the questions on migraine.

The data including cases and controls were next incorporated for self-reported cardio- and cerebrovascular risk factors for hypertension, high serum cholesterol, any diabetes, myocardial infarction, angina pectoris, ischemic stroke, or other cere- brovascular disorders, based on whether a doctor had told the respondent that he/she has or has had such a disorder.

In the present HeSSup migraine data, the occurrence of self-reported disorders under study was assessed in the migraine and control groups by using the Chi- squared test to study statistical differences.

Odds Ratios (OR) with 95% confidence intervals (CI) were assessed for diagno- ses drawn from the National Institute for Health and Welfare for AMI (I21−I22), for ischemic stroke (I63), and for TIA (G45) in the migraine and control groups.

Results The occurrence of migraine was 13%, and most of all migraine patients (62%) belonged to the two oldest (54–58 and 64–68 years) age groups in 2012.

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2 Mechanisms

In the univariate conditional logistic regression analysis in the age groups 54–58 and 64–68 years, ischemic stroke (OR 95% CI: 2.57, 1.28–5.17) and TIA (OR 95% CI: 3.20, 1.45–7.05) were statistically significant among migraine patients.

The average age at diagnosed TIA was lower among migraineurs compared to

the controls (56.4 vs 58.7 years, p = 0.004).

In ischemic stroke, the corresponding ages were similar, 56.5 vs 57.1 years (p =

0.053) and in myocardial infarction, 55.3 vs 57.7 years (p = 0.849).

Discussion An increased risk for ischemic stroke was observed among women and in older age-groups.

In our data, the increased five-fold risk for ischemic stroke and more than three- fold risk for TIA among women in age-groups over 54 years are significantly higher than the risk observed among men.

The frequency of migraine has also been shown to be a risk factor for stroke among women aged 25–42 years, as shown in the Women’s Health Study [446], but this has not been identified in older age-groups.

Stroke risk factors and migraine subtypes and patterns remain important con- founders in future studies concerning the overall risk and especially the age-specific gender risk.

Our results on low female coronary artery disease risk are in contrast with the results among the participants of the Women’s Health Study, where an association with migraine and any cardiovascular disease, coronary events, and cardiovascular mortality was shown [446].

Conclusions The data in this study show that any migraine in the adult population associates with a high occurrence of known vascular risk factors.

This paper is among the few studies pointing out higher ischemic stroke and TIA

risk among women with migraine in older age groups.

There is a need to anticipate vascular risk and recognize both sex-specific and

general risk factors in all migraine age groups.

Acknowledgement A machine generated summary based on the work of Sumelahti, Marja-Liisa; Sumanen, Merika S.; Mattila, Kari J.; Sillanmäki, Lauri; Sumanen, Markku. 2021 in BMC Public Health

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