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Myocardial infarction, stroke and cardiovascular mortality among migraine patients: a systematic review and meta-analysis

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Abstract

Background

An increasing number of studies have shown an association between migraine and cardiovascular disease, in particular cardio- and cerebro-vascular events.

Methods

Three electronic databases (PubMed, Embase and Scopus) were searched from inception to May 22, 2021 for prospective cohort studies evaluating the risk of myocardial infarction, stroke and cardiovascular mortality in migraine patients. A random effects meta-analysis model was used to summarize the included studies.

Results

A total of 18 prospective cohort studies were included consisting of 370,050 migraine patients and 1,387,539 controls. Migraine was associated with myocardial infarction (hazard ratio, 1.36; 95% CI, 1.23–1.51; p =  < 0.001), unspecified stroke (hazard ratio, 1.30; 95% CI, 1.07–1.60; p = 0.01), ischemic stroke (hazard ratio, 1.35; 95% CI, 1.03–1.78; p = 0.03) and hemorrhagic stroke (hazard ratio, 1.43; 95% CI, 1.07–1.92; p = 0.02). Subgroup analysis of migraine with aura found a further increase in risk of myocardial infarction and both ischemic and hemorrhagic stroke, as well as improved substantial statistical heterogeneity. Migraine with aura was also associated with an increased risk of cardiovascular mortality (hazard ratio, 1.27; 95% CI, 1.14–1.42; p =  < 0.001).

Conclusion

Migraine, especially migraine with aura, is associated with myocardial infarction and stroke. Migraine with aura increases the risk of overall cardiovascular mortality.

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Availability of data and materials

Data used for this study can be accessed upon request from the Principal Investigator (Dr. Ching-Hui Sia) at: ching_hui_sia@nuhs.edu.sg.

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Funding

BYQT is a recipient of the Ministry of Health Healthcare Research Scholarship, Singapore. He is concurrently supported by the Chan Heng Leong Research Award. CS is supported by the National University of Singapore Yong Loo Lin School of Medicine’s Junior Academic Faculty Scheme.

Author information

Author notes

  1. Chester Yan Hao Ng and Benjamin Y. Q. Tan have contributed equally as first authors.

  2. Ching-Hui Sia and Jonathan J. Y. Ong have co-supervised this study as senior authors.

Authors and Affiliations

  1. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Chester Yan Hao Ng, Benjamin Y. Q. Tan, Yao Neng Teo, Yao Hao Teo, Nicholas L. X. Syn, Aloysius S. T. Leow, Mark Y. Chan, Raymond C. C. Wong, Ping Chai, Amanda Chee Yun Chan, Vijay Kumar Sharma, Leonard L. L. Yeo, Ching-Hui Sia & Jonathan J. Y. Ong

  2. Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore

    Benjamin Y. Q. Tan, Amanda Chee Yun Chan, Vijay Kumar Sharma, Leonard L. L. Yeo & Jonathan J. Y. Ong

  3. Academic Foundation Year Programme, North Middlesex University Hospital Trust, London, UK

    Jamie S. Y. Ho

  4. Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore, Singapore

    Mark Y. Chan, Raymond C. C. Wong, Ping Chai & Ching-Hui Sia

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  1. Chester Yan Hao Ng
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CYHN, BYQT, CS and JJYO designed the study and developed the study protocol and tools. CYHN, BYQT and CS were responsible for data collection. CYHN, BYQT, YNT, YHT, NLXS, CS and JJYO analyzed the data and wrote the manuscript. All authors contributed to the conceptualization of the research questions, interpretation of the results and manuscript writing. All authors read and approved the final manuscript.

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Correspondence to Ching-Hui Sia.

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Ng, C.Y.H., Tan, B.Y.Q., Teo, Y.N. et al. Myocardial infarction, stroke and cardiovascular mortality among migraine patients: a systematic review and meta-analysis. J Neurol 269, 2346–2358 (2022). https://doi.org/10.1007/s00415-021-10930-x

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  • DOI: https://doi.org/10.1007/s00415-021-10930-x

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