Friday , July 30 2021

Migraine with aura associated with a higher afibi risk

Action points

  • Based on patients in the ARIC cohort study, the researchers found a higher incidence of atrial fibrillation (Afib) over 20 years of observation in migraine patients with aura compared to migraine patients without aura and patients without headache.
  • Migraine with aura remained significantly associated with the Afib incident even after adjustment for age, sex, race, hypertension, diabetes, hypercholesterolemia, smoking, coronary heart disease and congestive heart failure.

Migraine with visual aura was associated with an increased risk of atrial fibrillation (Afib), which was demonstrated by a large cohort study in the US.

After adjusting to many factors, people with migraine with aura were 30% more likely than people who did not have headaches and 39% more often than those who had migraine without aura to develop Afib, reports Souvik Sen, MD, MS , MPH, from the University of South Carolina in Colombia and colleagues from Neurology.

"Epidemiological studies show that migraine with aura is associated with an increased risk of stroke, especially in the young population," said Sen MedPage today.

"In the past, we noticed that the relationship was particularly strong between migraine with aura and a subtype of stroke with embolic attack," he said. "Atrial fibrillation is the most common cause of infarction with ischemic cardiovascular system: if migraine with aura is associated with atrial fibrillation, atrial fibrillation can lead to thrombosis with embolism in the cerebral blood vessels, leading to ischemic strokes."

Earlier this year, a cohort study in Denmark showed links between migraine, stroke, myocardial infarction, afibic and atrial flutter, noting that cardiovascular relationships were more potent in patients with migraine with aura than without.

In the new study, Sen and his team used a population atopiciosclerosis risk population (ARIC), longitudinal studies established to analyze the causes of atherosclerosis and clinical outcomes in four US communities. ARIC participants had an interview about migraine history in 1993-1995 and were followed in the case of the Afib incident until 2013.

The researchers examined 11,939 people without prior aphasia or stroke. The participants had an average of 60 years at the end of the observation; 56% are women and 77% are white. A total of 426 people reported migraine with visual aura, 1090 migraines without visual aura, 1018 migraine headaches and 9405 without headaches.

The group without headache was older (mean age 60.4) than the migraine group (mean age 58.4) and had a higher percentage of men, people from Africa, patients with diabetes, smokers, people consuming alcohol and people with coronary artery disease. The migraine group had a higher percentage of hypercholesterolemia and a higher level of total cholesterol than the group without headache. During the 20-year follow-up period, the Afib case was reported in 15% of migraineurs and 17% of people without headache.

After adjusting for age, sex, race, hypertension, diabetes, smoking, hypercholesterolemia, coronary heart disease and congestive heart failure, migraine with visual aura was associated with an increased risk of Afib compared with no headache (HR 1.30, 95% CI 1.03-1.62) and compared to migraine without a visual aura (HR 1.39, 95% CI 1.05-1.83). Estimated serum frequency was 9.1 / 1000 person-years in migraine with visual aura and 6.9 / 1000 person-years in migraine without visual group.

The incidence of stroke in migraine with aura group (4.1 / 1000 person-years) was approximately twice as high as in people who had migraine without aura (2.07 / 1000 person-years) and was higher than in the group without headache (3.02) 1000 person-years). Mediational analysis suggests that atrial fibrillation was a migraine mediator with the visual risk of ischemic stroke associated with aura.

The relationship between migraine and visual aura, Afib and ischemic stroke is intriguing – noted Sebastian Fridman, MD, MPH and Luciano Sposato, both from the University of West, London, in a Canadian edition accompanying the editorial article.

'Researchers suggest that migraine precedes atrial fibrillation, and the latter is the culprit behind the greater risk of cardiogenic embolism in migraine patients with a visual aura,' wrote Fridman and Sposato. And although this hypothesis is probably the most reasonable, they have noticed that other options need to be considered.

"What if some cases of migraine with a visual aura are a clinical expression of cerebral brain micro-eventration from the left atrium or left atrium after paroxysmal atrial fibrillation? Or at least a subgroup of migraines with a visual aura can be considered as atrial fibrillation-related transient ischemic attacks? it is "yes" – we read in the article.

"In this case, it would be reasonable to expect a high risk of ischemic stroke associated with Afib in migraine patients with visual aura, exactly what Sen et al. Found in their studies," Fridman and Sposato added.

The study has several limitations, Sen and co-authors have been noticed. This could not account for immeasurable imbalances, including structural heart disease, such as enlargement of the left atrium or oval aperture. It is possible that a greater number of afib cases could have been identified by more systematic screening. In addition, people with migraines that lasted less than a year or who had a history of migraines at an earlier age could be excluded from the study, and information on migraine drugs – namely propranolol and triptans – was limited. affect the heart rate.

A randomized clinical trial can help determine if migraine patients with a visual aura would benefit from afib detection and prevention strategies for primary stroke, the researchers added.

The study was supported by the National Heart, Lung and Blood Institute and the American Heart Association.

The authors described the connections with Tian Medical.

Editors reported on relationships with Boehringer Ingelheim, Pfizer, the London Health Sciences Foundation and the Academic Medical Organization of Southwestern Ontario.

  • Reviewed by
    Dori F. Zaleznik, MD Associate Clinical Professor of Medicine (retired), Harvard Medical School, Boston and Dorothy Caputo, MA, BSN, RN, Nurse Planner

2018-11-14T16: 00: 00-0500

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