title: Migraine and cardiovascular disease in women and the role of aspirin: subgroup analyses in the Women's Health Study.
abstract: BACKGROUND
  Migraine with aura (MA) has been associated with increased risk of cardiovascular disease (CVD). The role of aspirin on this association remains unclear.
  
  
  METHODS
  Post-hoc subgroup analyses of the Women's Health Study, a randomized trial testing 100 mg aspirin on alternate days in primary prevention of CVD among 39,876 women aged ≥ 45.
  
  
  RESULTS
  During 10 years, 998 major CVD events were confirmed in 39,757 women with complete migraine information. Aspirin reduced risk of ischaemic stroke (relative risk, RR, 0.76, 95% CI 0.63-0.93) but not other CVD. Migraine or MA did not modify the effect of aspirin on CVD except for myocardial infarction (MI) (p for interaction = 0.01). Women with MA on aspirin had increased risk of MI (RR 3.72, 95% CI 1.39-9.95). Further exploratory analyses indicate that this increased risk is only apparent among women with MA on aspirin who ever smoked or had history of hypertension (p for interaction<0.01).
  
  
  CONCLUSIONS
  In post-hoc subgroup analyses, aspirin had similar protective effects on ischaemic stroke for women with or without migraine. By contrast, our data suggest that women with MA on aspirin had increased risk of MI. The small number of outcome events in subgroups, the exploratory nature of our analyses, and lack of plausible mechanisms raise the possibility of a chance finding, which must caution the interpretation.
authors.affiliation: Brigham and Women's Hospital, USA. tkurth@rics.bwh.harvard.edu
authors.forename: Tobias
authors.initials: T
authors.lastname: Kurth
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Diener
authors.forename: Julie E
authors.initials: JE
authors.lastname: Buring
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000150:complications* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008875:Middle Aged; D020325:Migraine with Aura / Q000150:complications*; D011322:Primary Prevention / Q000379:methods; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin