Coronary artery calcification score in migraine patients

DOI: https://doi.org/10.1038/s41598- 019- 50660- 9

Abstract-Summary Recent genetic and epidemiologic studies suggest, that atherosclerosis might be the overlapping pathophysiological mechanism in migraine and coronary heart disease. The aim of the present study was to evaluate if the increased cardiovascular risk

in migraineurs is attributed to an increased coronary artery calcification.

The coronary artery calcium score was assessed by computed tomography of the

heart in 1.437 patients of which 337 were migraineurs.

All patients had a similar cardiovascular risk profile, so that the risk for coronary and

similar between migraineurs

considered

could be

calcifications non-migraineurs.

This suggests that a more pronounced coronary artery calcification, as a surro- gate marker of coronary atherosclerosis, does not underlie the increased cardiovas- cular risk in migraineurs.

It has to be considered, that the coronary artery calcification score does not indi-

cate the total risk of atherosclerotic changes in the coronary arteries.

Introduction Genes are several ones, that specifically increase the risk for migraine and coronary heart disease (CHD), but also genes important for endothelial function, suggesting common biological processes contributing to both diseases [489].

This technique constitutes a fast and non-invasive tool that has been consis- tently shown to predict the risk of coronary heart disease with high accuracy [490–492].

Previous studies have shown, that about one to two percent of patients with no coronary calcification at all have considerable coronary atherosclerosis due to non- calcified plaques [493, 494].

To further investigate the common pathophysiological mechanism in migraine and coronary heart disease, as well as to clarify the association of migraine with an increased risk of cardiac events, we performed a CCT and determined the coronary artery calcium score (CACS) in migraineurs and non-migraineurs with a similar cardiovascular risk profile.

Methods The patients underwent coronary artery calcium (CAC) scanning due to suspected coronary artery disease (CAD).

Each patient signed written informed consent before CAC-scanning. Within this collective, patients suffering from migraine were identified according to the German translation of the second edition of the International classification of headache disorders (ICHD-II) [495].

Common risk factors for cardiovascular disease were evaluated for all patients by an interview with a trained physician and by reviewing the medical records of all patients.

2.3 Comorbidities

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Diabetes was defined as a fasting blood glucose level >110 mg/dl or treatment with a glucose-lowering agent; hypercholesterolemia was defined as a total choles- terol level >200 mg/dl or treatment with a lipid-lowering medication; hypertension was determined as a systolic blood pressure >140 mmHg or a diastolic value >90 mmHg; smoking was considered a risk factor when there was a positive smoking history within the previous 10 years.

Results The mean age of the patients was 58.4 ± 21.8 years.

The mean CAC-score (CACS) across the whole study population was 188 ± 133

and showed a positive correlation with the factor age.

The CACS was 5.1 ± 7.2 in patients younger than 30 years and 571 ± 627 in

patients older than 70 years (p < 0.001).

When comparing the CACS in patients with and without cardiovascular risk fac- tors, a significantly higher (p < 0.001) CACS was found in patients with a present cardiovascular risk factor: smokers had a CACS of 237 ± 201, patients with hyper- tension 289 ± 223, hypercholesterolemia 620 ± 455 and diabetes 712 ± 566, while patients without any risk factors had a CACS of 95 ± 51.

Discussion The purpose of our study was to evaluate the impact of migraine on the extent of CAC in a large cohort with similar cardiovascular risk factors.

In the present study migraine had no significant impact on the develop-

ment of CAC.

Since some past studies have reported a higher risk of CAD in migraineurs [496, 497], and with CACS predicting CAD [490–492], it was assumed, that migraine should also be associated with CACS.

This indicates, that additional and separate pathophysiological mechanisms apart from CAC might underlie the increased number of cardiovascular events in patients with migraine, which is in line with some previous findings showing even a lower rate of coronary artery calcification disease in migraineurs [498].

Due to this selection bias the prevalence of cardiovascular risk factors and CAC was disproportionately high in our cohort as compared to a selected cohort of migraine patients.

Conclusion Migraine does not correlate with an increased coronary artery calcification score in the present cohort; thus, it seems that the increased cardiovascular risk in patients with migraine is not due to a more pronounced atherosclerosis of the coronary arteries.

A higher amount of non-calcified plaques leading to more prevalent and severe coronary atherosclerosis in migraineurs cannot be sufficiently ruled out, since we did not perform CT angiography of the coronary arteries systematically.

Acknowledgement A machine generated summary based on the work of Filippopulos, Filipp M.; Schoeberl, Florian; Becker, Hans-Christoph; Becker-Bense, Sandra; Eren, Ozan; Straube, Andreas; Becker, Alexander. 2019 in Scientific Reports.

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2 Mechanisms

The relationship between migraine headache and asthma features