BMJ:偏头痛女性更容易患心脏病
2016/06/09
5月31日,BMJ杂志上的一项大型研究表明,与无偏头痛的女性相比,患有偏头痛的女性心血管疾病风险略有增加,并更有可能死于该疾病。


5月31日,BMJ杂志上的一项大型研究表明,与无偏头痛的女性相比,患有偏头痛的女性心血管疾病风险略有增加,并更有可能死于该疾病。专家认为,这些结果为偏头痛作为心血管疾病的重要标志物提供了证据,但仍需更多的研究来确定其他可能因素以及治疗或预防偏头痛能否降低心血管疾病的风险。

偏头痛和卒中风险有一定关联,但很少有研究揭示偏头痛与心血管疾病及死亡率的相关性,因此美国和德国的研究人员进行了一项大规模的前瞻性研究以评估偏头痛和心血管疾病及其死亡率之间的关联性。

研究人员分析了来自“Nurses' Health Study II”的115541名女性数据,这些参与者的年龄在25-42岁之间,无心绞痛或心血管疾病症状。研究人员观察了所有参与者在1989年至2011年之间的心血管事件发生率及死亡率。在基线期,15.2%的女性被诊断为偏头痛,在随访的20年中,共有1329例心血管疾病发生,其中233例死亡。当与无偏头痛女性相比,患有偏头痛的女性患心血管疾病的风险更大些,包括心脏病发作、中风以及心绞痛。当排除其他风险因素后,这种关联仍存在。

此外,研究发现偏头痛和心血管疾病死亡率高风险相关,这种关联在高龄、吸烟、高血压及使用激素疗法或口服避孕药的女性群体中表现相似。哈佛医学院Rebecca Burch和纽约州立大学的Melissa Rayhill在一篇相关的社论中警告,“这种风险不应该被过分强调,因为这在个体水平上影响很小,但在整体水平上却有很大的影响,因为偏头痛真的很普遍。”

然而,当前研究仍存在大量的局限性,没有可用的心血管生物标志物信息以及偏头痛的细节如偏头痛先兆等。尽管如此,作者表示,“这些结果进一步提供证据表明偏头痛可作为心血管疾病的重要危险标志物,至少在女性中是这样”,然而该结论并不适用于男性。因此研究人员最后下结论:鉴于一般人群中偏头痛的患病率很高,因而需要了解其所涉及的生物过程,从而为患者提供预防性的解决方案。

对于将偏头痛纳入晚年心血管的风险标志物,Rebecca Burch和Melissa Rayhill表示赞同。他们认为这项研究虽然提出了通过减少偏头痛的发作频率或严重程度来降低晚年心血管疾病风险的想法,但在更好地了解偏头痛和心血管疾病的相关机制之前,仍需谨慎和克制。

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  • Migraine and risk of cardiovascular disease in women: prospective cohort study

    Objective To evaluate the association between migraine and incident cardiovascular disease and cardiovascular mortality in women. Design Prospective cohort study among Nurses’ Health Study II participants, with follow-up from 1989 and through June 2011. Setting Cohort of female nurses in United States. Participants 115 541 women aged 25-42 years at baseline and free of angina and cardiovascular disease. Cumulative follow-up rates were more than 90%. Main outcome measures 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.

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