Migraine and cardiovascular disease: systematic review and meta-analysis
Migraine and cardiovascular disease: systematic review and meta-analysis
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DOI：
10.1136/bmj.b3914
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发表时间：
2009-10-27
影响因子：
105.7
通讯作者：
Kurth, Tobias
中科院分区：
文献类型：
--
作者：
Schuerks, Markus;Rist, Pamela M.;Kurth, Tobias
目的评价偏头痛与心血管疾病（包括中风、心肌梗死和心血管疾病死亡）之间的关系。设计系统综述和荟萃分析。数据来源电子数据库（PubMed，Embase，科克伦图书馆）和2009年1月前发表的纳入研究和综述的参考文献列表。对照和队列研究调查任何偏头痛或特定偏头痛亚型和心血管疾病之间的关联。分歧以协商一致方式解决。根据偏头痛和心血管疾病的先验类别对研究进行分组。数据提取两名研究人员提取数据。合并相对危险度和95%的置信区间进行了calculated.Results研究是异质性的参与者的特点和心血管疾病的定义。9项研究调查了任何偏头痛和缺血性卒中之间的关系（合并相对危险度1.73，95%置信区间1.31至2.29）。其他分析表明，与无先兆偏头痛患者（1.23，0.90至1.69;先兆状态的荟萃回归P=0.02）相比，有先兆偏头痛患者（2.16，1.53至3.03）的风险显著更高。此外，结果表明，与男性（1.37，0.89至2.11）相比，女性（2.08，1.13至3.84）的风险更大。年龄小于45岁，吸烟和口服避孕药的使用进一步增加了风险。8项研究调查了偏头痛与心肌梗死之间的关系（1.12，0.95至1.32），5项研究调查了偏头痛与心血管疾病死亡之间的关系（1.03，0.79至1.34）。只有一项研究调查了妇女偏头痛先兆和心肌梗死和死亡之间的关联，由于心血管疾病，显示了两倍的风险增加。结论偏头痛与缺血性中风的风险增加了一倍，这是唯一明显的偏头痛先兆的人。我们的研究结果还表明，女性的风险更高，年龄小于45岁的偏头痛患者，吸烟者和使用口服避孕药的女性的风险进一步放大。我们没有发现任何偏头痛与心肌梗死或心血管疾病导致的死亡之间的总体相关性。很少有研究能够可靠地评估修正因素（如偏头痛先兆）对这些关联的影响。
Objective To evaluate the association between migraine and cardiovascular disease, including stroke, myocardial infarction, and death due to cardiovascular disease.Design Systematic review and meta-analysis.Data sources Electronic databases (PubMed, Embase, Cochrane Library) and reference lists of included studies and reviews published until January 2009.Selection criteria Case-control and cohort studies investigating the association between any migraine or specific migraine subtypes and cardiovascular disease.Review methods Two investigators independently assessed eligibility of identified studies in a two step approach. Disagreements were resolved by consensus. Studies were grouped according to a priori categories on migraine and cardiovascular disease.Data extraction Two investigators extracted data. Pooled relative risks and 95% confidence intervals were calculated.Results Studies were heterogeneous for participant characteristics and definition of cardiovascular disease. Nine studies investigated the association between any migraine and ischaemic stroke (pooled relative risk 1.73, 95% confidence interval 1.31 to 2.29). Additional analyses indicated a significantly higher risk among people who had migraine with aura (2.16, 1.53 to 3.03) compared with people who had migraine without aura (1.23, 0.90 to 1.69; meta-regression for aura status P=0.02). Furthermore, results suggested a greater risk among women (2.08, 1.13 to 3.84) compared with men (1.37, 0.89 to 2.11). Age less than 45 years, smoking, and oral contraceptive use further increased the risk. Eight studies investigated the association between migraine and myocardial infarction (1.12, 0.95 to 1.32) and five between migraine and death due to cardiovascular disease (1.03, 0.79 to 1.34). Only one study investigated the association between women who had migraine with aura and myocardial infarction and death due to cardiovascular disease, showing a twofold increased risk.Conclusion Migraine is associated with a twofold increased risk of ischaemic stroke, which is only apparent among people who have migraine with aura. Our results also suggest a higher risk among women and risk was further magnified for people with migraine who were aged less than 45, smokers, and women who used oral contraceptives. We did not find an overall association between any migraine and myocardial infarction or death due to cardiovascular disease. Too few studies are available to reliably evaluate the impact of modifying factors, such as migraine aura, on these associations.