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 27 858 women (mean [SD] age at baseline, 54.7 [7.1] years), among whom 1435 (5.2%) had migraine with aura and 26 423 (94.8%) did not (2177 [7.8%] had migraine without aura and 24 246 [87.0%] had no migraine in the year prior to baseline). During a mean follow-up of 22.6 years (629 353 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.

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偏头痛与先兆和其他危险因素与女性心血管疾病的关联

重要性 已知有先兆的偏头痛会增加心血管疾病 (CVD) 的风险。与其他 CVD 危险因素相关的先兆偏头痛对 CVD 发病率的绝对贡献仍不清楚。目的 估计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。设计、设置和参与者 美国女性健康专业人员（女性健康研究队列）在基线（1992-1995 年）进行血脂测量且无心血管疾病，随访至 2018 年 12 月 31 日。无先兆偏头痛或基线时无偏头痛。主要结果和测量 主要结果是严重的 CVD（首次心肌梗死、卒中或 CVD 死亡）。广义建模程序用于按风险因素状态计算主要 CVD 事件的多变量调整发病率，其中包括队列中的所有女性。结果 研究人群包括 27 858 名女性（基线时平均 [SD] 年龄，54.7 [7.1] 岁），其中 1435 名（5.2%）有先兆偏头痛，26 423 名（94.8%）没有（2177 [7.8%]有无先兆偏头痛，24 246 [87.0%] 在基线前一年没有偏头痛）。在 22.6 年（629 353 人年）的平均随访期间，发生了 1666 起主要 CVD 事件。有先兆偏头痛的女性每 1000 人年的主要 CVD 调整后发病率为 3.36（95% CI，2.72-3.99），而无先兆偏头痛或无偏头痛的女性为 2.11（95% CI，1.98-2.24）。 P < .001)。有先兆偏头痛女性的发病率显着高于肥胖（2.29 [95% CI，2.02-2.56]）、高甘油三酯（2.67 [95% CI，2.38-2.95]）或低高密度脂蛋白胆固醇 (2.63 [95% CI, 2.33-2.94])，但与收缩压升高 (3.78 [95% CI, 2.76-4.81])、总胆固醇高的人群的发生率没有显着差异(2.85 [95% CI, 2.38-3.32])，或心肌梗死家族史 (2.71 [95% CI, 2.38-3.05])。糖尿病女性 (5.76 [95% CI, 4.68-6.84]) 或目前吸烟的女性 (4.29 [95% CI, 3.79-4.79]) 的发病率明显高于有先兆偏头痛的女性。先兆偏头痛发病率的递增幅度为 1。每 1000 人年增加 01 例，如果添加到肥胖中，则每 1000 人年增加 2.57 例，添加到糖尿病中。结论和相关性 在这项针对至少 45 岁女性卫生专业人员的研究中，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的 CVD 调整后发病率更高。这些发现的临床重要性，以及它们是否可以推广到该研究人群之外，需要进一步研究。