德国柏林查尔特大学医学院Tobias Kurth联合美国布列根和妇女医院Julie E. Buring团队分析了先兆偏头痛及其他危险因素与心血管疾病的相关性。2020年6月9日，《美国医学会杂志》发表了这一成果。

已知患先兆偏头痛会增加心血管疾病（CVD）的风险。先兆偏头痛对CVD发病率的绝对贡献与其他心血管病危险因素的关系尚不清楚。

为了评估先兆偏头痛女性相对于其他主要血管危险因素女性的CVD发病率，1992-1995年，研究组招募了27858名健康专业的女性，进行血脂检测，基线时均没有CVD。主要CVD结果包括首次心肌梗塞、中风或CVD死亡。

27858名女性基线时的中位年龄为54.7岁，其中1435名（5.2%）患有先兆偏头痛，26423名（94.8％）未患先兆偏头痛，但其中2177名在基线前一年曾患过无先兆偏头痛。在平均22.6年（629353人-年）的随访期间，共发生1666起主要CVD事件。先兆偏头痛女性经校正后，主要CVD发生率为每1000人-年3.36例，显著高于无先兆偏头痛或没有偏头痛的女性（2.11例）。

患先兆偏头痛的女性CVD发生率显著高于肥胖女性（每1000人-年2.29例）、高甘油三酸酯女性（2.67例）或高密度脂蛋白胆固醇低的女性（2.63例），但与收缩压升高女性（3.78例）、总胆固醇高的女性（2.85例）或有心肌梗塞家族史的女性（2.71例）相比无显著差异。糖尿病女性（5.76例）或吸烟女性（4.29例）的CVD发病率显著高于先兆偏头痛的女性。先兆偏头痛女性CVD发病率增加幅度从每1000人年增加1.01例（合并肥胖）到增加2.57例（合并糖尿病）不等。

总之，与无先兆偏头痛或无偏头痛的女性相比，有先兆偏头痛的女性经校正后CVD发生率更高。

附：英文原文

Title: Association of Migraine With Aura and Other Risk Factors With Incident Cardiovascular Disease in Women

Author: Tobias Kurth, Pamela M. Rist, Paul M Ridker, Gregory Kotler, Vadim Bubes, Julie E. Buring

Issue&Volume: 2020/06/09

Abstract: Importance  Migraine with aura is known to increase the risk of cardiovascular disease (CVD). The absolute contribution of migraine with aura to CVD incidence in relation to other CVD risk factors remains unclear.

Objective  To estimate the CVD incidence rate for women with migraine with aura relative to women with other major vascular risk factors.

Design, Setting, and Participants  Female health professionals in the US (the Women’s Health Study cohort) with lipid measurements and no CVD at baseline (1992-1995) were followed up through December 31, 2018.

Exposures  Self-reported migraine with aura compared with migraine without aura or no migraine at baseline.

Main Outcomes and Measures  The primary outcome was major CVD (first myocardial infarction, stroke, or CVD death). Generalized modeling procedures were used to calculate multivariable-adjusted incidence rates for major CVD events by risk factor status that included all women in the cohort.

Results  The study population included 27858 women (mean [SD] age at baseline,54.7 [7.1] years), among whom 1435 (5.2%) had migraine with aura and 26423 (94.8%) did not (2177 [7.8%] had migraine without aura and 24246 [87.0%] had no migraine in the year prior to baseline). During a mean follow-up of 22.6 years (629353 person-years), 1666 major CVD events occurred. The adjusted incidence rate of major CVD per 1000 person-years was 3.36 (95% CI, 2.72-3.99) for women with migraine with aura vs 2.11 (95% CI, 1.98-2.24) for women with migraine without aura or no migraine (P<.001). The incidence rate for women with migraine with aura was significantly higher than the adjusted incidence rate among women with obesity (2.29 [95% CI, 2.02-2.56]), high triglycerides (2.67 [95% CI, 2.38-2.95]), or low high-density lipoprotein cholesterol (2.63 [95% CI, 2.33-2.94]), but was not significantly different from the rates among those with elevated systolic blood pressure (3.78 [95% CI, 2.76-4.81]), high total cholesterol (2.85 [95% CI, 2.38-3.32]), or family history of myocardial infarction (2.71 [95% CI, 2.38-3.05]). Incidence rates among women with diabetes (5.76 [95% CI, 4.68-6.84]) or who currently smoked (4.29 [95% CI, 3.79-4.79]) were significantly higher than those with migraine with aura. The incremental increase in the incidence rate for migraine with aura ranged from 1.01 additional cases per 1000 person-years when added to obesity to 2.57 additional cases per 1000 person-years when added to diabetes.

Conclusions and Relevance  In this study of female health professionals aged at least 45 years, women with migraine with aura had a higher adjusted incidence rate of CVD compared with women with migraine without aura or no migraine. The clinical importance of these findings, and whether they are generalizable beyond this study population, require further research.

DOI: 10.1001/jama.2020.7172

Source: https://jamanetwork.com/journals/jama/article-abstract/2766867