Migraine and increased cardiovascular disease risk: interaction with traditional risk factors and lifestyle factors

Migraine has been linked to a heightened risk of cardiovascular disease, and acute treatment drugs, such as triptans, might increase this risk. This study aimed to determine whether the elevated cardiovascular risk is primarily attributable to the underlying migraine condition or the treatment modalities utilized. Additionally, we investigated the effects of managing traditional cardiovascular risk factors and the influence of healthy lifestyle scores on this association. This population-based investigation leveraged data from the UK Biobank, encompassing participants recruited between 2006 and 2010, to examine the association between migraine and the long-term risk of atherosclerotic cardiovascular disease and its subtypes. Cox proportional hazard models were employed to conduct this analysis. Furthermore, the study evaluated the relative importance of migraine in predicting atherosclerotic cardiovascular disease by calculating the R² values of the Cox models. Additionally, multiplicative and additive interaction analyses were conducted to examine whether the association between migraine and cardiovascular disease varies based on the degree of risk factor control and lifestyle scores. Across an average follow-up span of 12.9 years, a total of 24,038 cardiovascular events were documented, comprising 12,451 cases of coronary heart disease, 3,608 cases of ischemic stroke, and 4,493 cases of peripheral artery disease. In a thoroughly adjusted analysis, individuals with migraine demonstrated an increased risk of atherosclerotic cardiovascular disease, with a hazard ratio of 1.12 (95% confidence interval: 1.05 to 1.20) compared to those without migraine, indicating a significant trend (PFDR< 0.001). Among female participants under 45 years of age, migraine emerged as a stronger predictor of ASCVD risk than certain lifestyle factors. Furthermore, a significant interaction between migraine and an unhealthy lifestyle was observed in ASCVD risk, evident at both additive and multiplicative levels (P for additive interaction = 0.016; P for multiplicative interaction = 0.041). However, the interactions between migraine and the degree of traditional risk factor control did not reach statistical significance. Additionally, the acute treatment of migraine, including the use of triptans, was not significantly associated with ASCVD risk. A significant interaction exists between unhealthy lifestyles and migraine, where their combined effects may contribute to an elevated risk of cardiovascular diseases, potentially amplifying the impact of each factor. Developing effective lifestyle intervention strategies tailored for migraine patients could help improve their long-term cardiovascular health, emphasizing the importance of comprehensive risk management.