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Rates of Vascular Events in Patients With Migraine: A MarketScan® Database Retrospective Cohort Study.


ABSTRACT:

Objective

To estimate the baseline rates of vascular events among people with migraine.

Background

Several novel medications that target the calcitonin gene-related peptide (CGRP) pathway are approved to treat people with migraine. Given that the CGRP pathway also plays a role in maintaining cardiovascular homeostasis, determining the baseline rates of vascular events among people with migraine will help inform the safety of these novel medications.

Methods

In this retrospective cohort study, patients 18- to 64-year-old patients with migraine were identified from the MarketScan® database (January 2013-December 2017) and were categorized into 4 vascular risk categories: migraine with aura; and high, medium, and low vascular risk. Event rates (per 1000 person-years [PY]) for 19 vascular events were estimated overall, by risk category, and by baseline characteristics.

Results

Among 1,195,696 patients with migraine, 4.8% (57,853/1,195,696) had migraine with aura, and 2.8% (33,949/1,195,696), 15.5% (184,782/1,195,696), and 77.9% (931,059/1,195,696) were at high, medium, and low risk of vascular events, respectively. Rates of ischemic stroke (per 1000 PY) were 5.1 (95% confidence interval [CI]: 5.0, 5.2) overall, 8.6 (95% CI: 8.1, 9.1) for patients with migraine aura, 47.2 (95% CI: 45.3, 49.0) in the high-risk group, 9.4 (95% CI: 9.1, 9.7) in the medium-risk group, and 2.9 (95% CI: 2.9, 3.0) in the low-risk group. Rates of acute myocardial infarction (per 1000 PY) were 1.8 (95% CI: 1.8, 1.9) overall, 1.9 (95% CI: 1.7, 2.2) for patients with migraine aura, 14.0 (95% CI: 13.0, 14.9) in the high-risk group, 3.9 (95% CI: 3.7, 4.1) in the medium-risk group, and 1.1 (95% CI: 1.0, 1.1) in the low-risk group. High-risk patients had the highest rates of each of 19 evaluated vascular events, and rates were higher for men, older age groups, and those with higher comorbidity scores, medication usage, and medical utilization.

Conclusion

Our findings provide recent rates of vascular disease in patients with migraine. In the future, this information will be useful to help inform clinical risk:benefit decision making when assessing the use of therapies such as CGRP antagonists for migraine.

SUBMITTER: Gill K 

PROVIDER: S-EPMC7756746 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Rates of Vascular Events in Patients With Migraine: A MarketScan<sup>®</sup> Database Retrospective Cohort Study.

Gill Karminder K   Chia Victoria M VM   Hernandez Rohini K RK   Navetta Marco M  

Headache 20201103 10


<h4>Objective</h4>To estimate the baseline rates of vascular events among people with migraine.<h4>Background</h4>Several novel medications that target the calcitonin gene-related peptide (CGRP) pathway are approved to treat people with migraine. Given that the CGRP pathway also plays a role in maintaining cardiovascular homeostasis, determining the baseline rates of vascular events among people with migraine will help inform the safety of these novel medications.<h4>Methods</h4>In this retrospe  ...[more]

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