title: Migraine and risk of cardiovascular disease in women: prospective cohort study.
abstract: OBJECTIVE
  To evaluate the association between migraine and incident cardiovascular disease and cardiovascular mortality in women.
  
  
  METHODS
  Prospective cohort study among Nurses' Health Study II participants, with follow-up from 1989 and through June 2011.
  
  
  METHODS
  Cohort of female nurses in United States.
  
  
  METHODS
  115 541 women aged 25-42 years at baseline and free of angina and cardiovascular disease. Cumulative follow-up rates were more than 90%.
  
  
  METHODS
  The primary outcome of the study was major cardiovascular disease, a combined endpoint of myocardial infarction, stroke, or fatal cardiovascular disease. Secondary outcome measures included individual endpoints of myocardial infarction, stroke, angina/coronary revascularization procedures, and cardiovascular mortality.
  
  
  RESULTS
  17 531 (15.2%) women reported a physician's diagnosis of migraine. Over 20 years of follow-up, 1329 major cardiovascular disease events occurred and 223 women died from cardiovascular disease. After adjustment for potential confounding factors, migraine was associated with an increased risk for major cardiovascular disease (hazard ratio 1.50, 95% confidence interval 1.33 to 1.69), myocardial infarction (1.39, 1.18 to 1.64), stroke (1.62, 1.37 to 1.92), and angina/coronary revascularization procedures (1.73, 1.29 to 2.32), compared with women without migraine. Furthermore, migraine was associated with a significantly increased risk for cardiovascular disease mortality (hazard ratio 1.37, 1.02 to 1.83). Associations were similar across subgroups of women, including by age (<50/≥50), smoking status (current/past/never), hypertension (yes/no), postmenopausal hormone therapy (current/not current), and oral contraceptive use (current/not current).
  
  
  CONCLUSIONS
  Results of this large, prospective cohort study in women with more than 20 years of follow-up indicate a consistent link between migraine and cardiovascular disease events, including cardiovascular mortality. Women with migraine should be evaluated for their vascular risk. Future targeted research is warranted to identify preventive strategies to reduce the risk of future cardiovascular disease among patients with migraine.
authors.affiliation: Institute of Public Health, Charité - Universitätsmedizin, D-10117 Berlin, Germany Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA tobias.kurth@charite.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Kurth
authors.affiliation: Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: Anke C
authors.initials: AC
authors.lastname: Winter
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: A Heather
authors.initials: AH
authors.lastname: Eliassen
authors.affiliation: Institute of Public Health, Charité - Universitätsmedizin, D-10117 Berlin, Germany.
authors.forename: Rimma
authors.initials: R
authors.lastname: Dushkes
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Mukamal
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Rimm
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Walter C
authors.initials: WC
authors.lastname: Willett
authors.affiliation: Institute of Public Health, Charité - Universitätsmedizin, D-10117 Berlin, Germany Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: JoAnn E
authors.initials: JE
authors.lastname: Manson
authors.affiliation: Institute of Public Health, Charité - Universitätsmedizin, D-10117 Berlin, Germany.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Rexrode
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D015984:Causality; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis / Q000453:epidemiology; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013223:Statistics as Topic; D014481:United States / Q000453:epidemiology