Dataset Information

Migraine and the risk of cardiovascular and cerebrovascular events: a meta-analysis of 16 cohort studies including 1 152 407 subjects.

ABSTRACT:

Objectives

To perform an updated meta-analysis to evaluate the long-term cardiovascular and cerebrovascular outcomes among migraineurs.

Setting

A meta-analysis of cohort studies performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data sources

The MEDLINE, Web of Science and Cochrane Central Register of Controlled Trials databases were searched for relevant articles.

Participants

A total of 16 cohort studies (18 study records) with 394?942 migraineurs and 757?465 non-migraineurs were analysed.

Primary and secondary outcome measures

Major adverse cardiovascular and cerebrovascular events (MACCE), stroke (ie, ischaemic, haemorrhagic or non-specified), myocardial infarction (MI) and all-cause mortality. The outcomes were reported at the longest available follow-up.

Data analysis

Summary-adjusted hazard ratios (HR) were calculated by random-effects Der-Simonian and Liard model. The risk of bias was assessed by the Newcastle-Ottawa Scale.

Results

Migraine was associated with a higher risk of MACCE (adjusted HR 1.42, 95%?confidence interval [CI] 1.26 to 1.60, P<0.001, I²=40%) driven by a higher risk of stroke (adjusted HR 1.41, 95%?CI 1.25 to 1.61, P<0.001, I²=72%) and MI (adjusted HR 1.23, 95%?CI 1.03 to 1.43, P=0.006, I²=59%). There was no difference in the risk of all-cause mortality (adjusted HR 0.93, 95%?CI 0.78 to 1.10, P=0.38, I²=91%), with a considerable degree of statistical heterogeneity between the studies. The presence of aura was an effect modifier for stroke (adjusted HR aura 1.56, 95%?CI 1.30 to 1.87 vs adjusted HR no aura 1.11, 95%?CI 0.94 to 1.31, P _interaction=0.01) and all-cause mortality (adjusted HR aura 1.20, 95%?CI 1.12 to 1.30 vs adjusted HR no aura 0.96, 95%?CI 0.86 to 1.07, P_interaction<0.001).

Conclusion

Migraine headache was associated with an increased long-term risk of cardiovascular and cerebrovascular events. This effect was due to an increased risk of stroke (both ischaemic and haemorrhagic) and MI. There was a moderate to severe degree of heterogeneity for the outcomes, which was partly explained by the presence of aura.

Prospero registration number

CRD42016052460.

SUBMITTER: Mahmoud AN

PROVIDER: S-EPMC5875642 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Migraine and the risk of cardiovascular and cerebrovascular events: a meta-analysis of 16 cohort studies including 1 152 407 subjects.

Mahmoud Ahmed N AN Mentias Amgad A Elgendy Akram Y AY Qazi Abdul A Barakat Amr F AF Saad Marwan M Mohsen Ala A Abuzaid Ahmed A Mansoor Hend H Mojadidi Mohammad K MK Elgendy Islam Y IY

BMJ open 20180327 3

<h4>Objectives</h4>To perform an updated meta-analysis to evaluate the long-term cardiovascular and cerebrovascular outcomes among migraineurs.<h4>Setting</h4>A meta-analysis of cohort studies performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.<h4>Data sources</h4>The MEDLINE, Web of Science and Cochrane Central Register of Controlled Trials databases were searched for relevant articles.<h4>Participants</h4>A total of 16 cohort studies (18 st ...[more]

PMID: 29593023

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Project description:ImportanceMajor adverse cardiovascular and cerebrovascular events (MACCE) are a significant source of perioperative morbidity and mortality following noncardiac surgery.ObjectiveTo evaluate national trends in perioperative cardiovascular outcomes and mortality after major noncardiac surgery and to identify surgical subtypes associated with cardiovascular events using a large administrative database of United States hospital admissions.Design, setting, participantsPatients who underwent major noncardiac surgery from January 2004 to December 2013 were identified using the National Inpatient Sample.Main outcomes and measuresPerioperative MACCE (primary outcome), defined as in-hospital, all-cause death, acute myocardial infarction (AMI), or acute ischemic stroke, were evaluated over time.ResultsAmong 10 581 621 hospitalizations (mean [SD] patient age, 65.74 [12.32] years; 5 975 798 female patients 56.60%]) for major noncardiac surgery, perioperative MACCE occurred in 317 479 hospitalizations (3.0%), corresponding to an annual incidence of approximately 150 000 events after applying sample weights. Major adverse cardiovascular and cerebrovascular events occurred most frequently in patients undergoing vascular (7.7%), thoracic (6.5%), and transplant surgery (6.3%). Between 2004 and 2013, the frequency of MACCE declined from 3.1% to 2.6% (P for trend <.001; adjusted odds ratio [aOR], 0.95; 95% CI, 0.94-0.97) driven by a decline in frequency of perioperative death (aOR, 0.79; 95% CI, 0.77-0.81) and AMI (aOR, 0.87; 95% CI, 0.84-0.89) but an increase in perioperative ischemic stroke from 0.52% in 2004 to 0.77% in 2013 (P for trend <.001; aOR 1.79; CI 1.73-1.86).Conclusions and relevancePerioperative MACCE occurs in 1 of every 33 hospitalizations for noncardiac surgery. Despite reductions in the rate of death and AMI among patients undergoing major noncardiac surgery in the United States, perioperative ischemic stroke increased over time. Additional efforts are necessary to improve cardiovascular care in the perioperative period of patients undergoing noncardiac surgery.

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Dataset Information

Migraine and the risk of cardiovascular and cerebrovascular events: a meta-analysis of 16 cohort studies including 1 152 407 subjects.

Objectives

Setting

Data sources

Participants

Primary and secondary outcome measures

Data analysis

Results

Conclusion

Prospero registration number

Publications

Migraine and the risk of cardiovascular and cerebrovascular events: a meta-analysis of 16 cohort studies including 1 152 407 subjects.

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