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Biomarkers fail to explain CVD, migraine link: genetic factors, environmental factors, or a high prevalence of CVD risk factors may play a role.

BOSTON -- Modest associations between migraine and adverse levels of certain cardiovascular biomarkers in a large cohort of women likely do not explain the connection between migraine and cardiovascular disease, Dr. Tobias Kurth said at the annual meeting of the American Academy of Neurology.

In a cross-sectional analysis of apparently healthy women aged 45 years and older who were followed for 10 years, the women with any history of migraine had small but statistically significant increased total cholesterol, non-HDL cholesterol, apolipoprotein B-100, and C-reactive protein (CRP) levels, compared with women who had no history of migraine, reported Dr. Kurth of Brigham and Women's Hospital, Boston.

In a previous study, Dr. Kurth and colleagues examined the association of migraine with subsequent risk of overall and specific cardiovascular disease (CVD) among American women aged 45 years or older who were participating in the prospective Women's Health Study sponsored by the National Heart, Lung, and Blood Institute and the National Cancer Institute. The women selected for the investigation were free of cardiovascular disease at study entry (in 1992-1995), and they contributed self-reported information on migraine and aura status and lipid measurements.

Compared with women who had no migraine history any history of migraine was associated with increased risk of CVD, and active migraine with aura was associated with increased risks of major CVD, ischemic stroke, myocardial infarction, death from ischemic CVD, coronary revascularization, and angina (JAMA 2006;296:283-91).

Because of the sparsity of available data on the association between migraine and cardiovascular biomarkers, the investigators sought to assess the potential relationship using 27,626 women from the same study sample for whom information on migraine and measured biomarkers was available. For the present study, they evaluated self-reported migraine and aura status with levels of total cholesterol, LDL cholesterol, HDL cholesterol, non-HDL cholesterol, apolipoprotein A-I, apolipoprotein B-100, lipoprotein, CRP, fibrinogen, soluble intercellular adhesion molecule 1, homocysteine, and creatinine.

For the investigation, elevated biomarkers were defined as the highest quintiles of biomarker levels among the women who were not taking postmenopausal hormones.

After adjustment for cardiovascular risk factors, the odds ratios for total cholesterol, non-HDL cholesterol, apolipoprotein B-100, and CRP in the 5,087 women with migraine history versus those without migraine were 1.09, 1.14, 1.09, and 1.13, respectively, reported Dr. Kurth.

The increases were most apparent among the 1,502 women who reported prior migraine. Among the 3,585 women who reported active migraine, there was no meaningful difference by aura status, he said.

"The association between migraine and the cardiovascular biomarkers are so weak that I cannot imagine the measured biomarkers are a likely explanation for the migraine/ cardiovascular disease association," Dr. Kurth said.

Although the precise mechanisms for the association between migraine and CVD remain unknown, "some hypotheses that are currently being discussed are an increase in the prevalence of cardiovascular disease risk factors among migraineurs, genetic factors, environmental factors, or a combination of these," said Dr, Kurth.

"Also, migraine treatments have been discussed [as possible contributors], but the available data make such a link unlikely, at least for therapeutic dosages, and contraindication for migraine-specific acute medications already include existing cardiovascular disease or high risk for cardiovascular disease," Dr. Kurth noted at the meeting.


New England Bureau
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Title Annotation:Clinical Rounds
Author:Mahoney, Diana
Publication:Family Practice News
Date:May 15, 2007
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