Abstract TMP105: Migraine With Aura Risk Score, Medication Use And Composite Cardiovascular

Abstract

Background: The migraine with aura risk score (MARS) was developed to predict the risk of ischemic stroke in patients with migraine with aura. Certain medications (estrogen replacement therapy-ERT, triptans and ergot alkaloids) have been postulated to increase cardiovascular risk. We tested if MARS or medications increased risk of ischemic stroke, cardiovascular event, and death. Methods: Migraine with aura patients (N=430) in the Atherosclerosis Risk in Communities Cohort were considered in this study. Those who had events prior to being evaluated were excluded leaving 420 patients. MARS was calculated at visit 3 (1993-1995) and patients were stratified as low (≤2) and high (≥3) risk groups. Medication uses were recorded on the same visit. Results: Of the 420 patients with a history of migraine with aura (age, mean±standard deviation=58.5±5.5, 349 female, 344 white), 49 patients had an ischemic stroke, 79 had a cardiovascular event, and 192 died during a 25-year follow-up period. The high-risk group was noted to have hazards ratio (HR) of 4.41 (95% CI 2.45-7.94) for ischemic stroke, 5.89 (95% CI 3.69-9.38) for cardiovascular event, and 3.56 (95% CI 2.66-4.79) for death, compared with the low-risk group. HR for composite events was 3.60 (95% CI 2.73-4.75). Kaplan-Meier Survival curves are depicted below (Logrank p<0.0001). Among medications only ERT (used in 34%) was associated with a significantly lower risk of composite events (HR 0.63, 95% CI 0.47-0.84), no significant difference for triptans (used in 1%) or ergot alkaloids (used in 4%). Conclusion: MARS≥3 increased the risk of composite events. Triptans and ergot alkaloids were not associated with increased risks and ERT was associated with a lower risk of composite events. The MARS finding needs validation in an external dataset and medication effects need confirmation in a randomized clinical trial.