BACKGROUND AND OBJECTIVES Migraine is linked to higher risks of myocardial infarction and ischemic stroke, but it is uncertain whether this risk is due to nonsteroidal anti-inflammatory drug (NSAID) use. This study aimed to examine the cardiovascular risks associated with migraine during time with and without NSAID use. METHODS We conducted a Danish nationwide population-based cohort study of individuals with a first-time hospital diagnosis of migraine (hospital-diagnosed) or at least 2 prescription fillings for migraine medication (primary care-diagnosed) between 1995 and 2021. We included comparison cohorts matched by birth year and sex from the general population. Exclusion criteria included previous migraine diagnosis, at least 2 prescription fillings for migraine medication, myocardial infarction, or ischemic stroke. We used the Aalen-Johansen estimator to calculate absolute risks and Cox regression to estimate adjusted hazard ratios (aHRs) for the association between migraine and the outcomes. RESULTS The study included 46,647 individuals with hospital-diagnosed migraine and 186,588 matched comparisons and 288,529 individuals with primary care-diagnosed migraine and 1,154,116 matched comparisons. Those with hospital-diagnosed migraine had higher 20-year risks of myocardial infarction (3.3% vs 2.2%; aHR 1.53; 95% CI 1.40-1.67) and ischemic stroke (4.5% vs 2.4%; aHR 1.94; 95% CI 1.80-2.10) than comparisons. These increased risks were comparable during time with and without NSAID use for myocardial infarction. For ischemic stroke, the point estimate remained increased during time with and without NSAID use, although it seemed higher during time without NSAID use (aHR 1.97; 95% CI 1.82-2.13) than with NSAID use (aHR 1.49; 95% CI 1.13-1.97). Individuals with primary care-diagnosed migraine overall did not have higher risks of the outcomes than comparisons, regardless of NSAID use. DISCUSSION The increased risk of myocardial infarction and ischemic stroke associated with hospital-diagnosed migraine could not be explained by NSAID-associated cardiovascular risks. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that NSAID-associated cardiovascular risks cannot explain the association between migraine and myocardial infarction or ischemic stroke.

中文翻译：

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使用非甾体抗炎药对偏头痛相关心肌梗死和缺血性中风风险的影响：一项基于人群的队列研究。


背景和目标 偏头痛与心肌梗死和缺血性中风的较高风险有关，但尚不确定这种风险是否是由于使用非甾体抗炎药 （NSAID） 造成的。本研究旨在检查使用和不使用 NSAID 期间与偏头痛相关的心血管风险。方法 我们对 1995 年至 2021 年间首次住院诊断为偏头痛（医院诊断）或至少 2 次偏头痛药物处方填充（初级保健诊断）的个体进行了一项丹麦全国性的人群队列研究。我们纳入了来自一般人群的按出生年份和性别匹配的比较队列。排除标准包括既往偏头痛诊断、至少 2 次偏头痛药物处方填充、心肌梗死或缺血性中风。我们使用 Aalen-Johansen 估计器计算绝对风险，使用 Cox 回归来估计偏头痛与结局之间关联的调整后风险比 （aHRs）。结果该研究包括 46,647 名医院诊断为偏头痛的个体和 186,588 例匹配的比较，以及 288,529 例初级保健诊断的偏头痛个体和 1,154,116 例匹配的比较。与对照组相比，医院诊断为偏头痛的患者 20 年心肌梗死风险更高（3.3% 对 2.2%;aHR 1.53;95% CI 1.40-1.67）和缺血性卒中风险（4.5% 对 2.4%;aHR 1.94;95% CI 1.80-2.10）。在使用 NSAID 治疗心肌梗死和不使用 NSAID 期间，这些增加的风险是相当的。对于缺血性卒中，使用和不使用 NSAID 的时间点估计值仍然增加，尽管在不使用 NSAID 期间（aHR 1.97;95% CI 1.82-2.13）似乎高于使用 NSAID（aHR 1.49;95% CI 1.13-1.97）。 无论是否使用 NSAID，初级保健诊断为偏头痛的个体总体上没有比对照组更高的结局风险。讨论 与医院诊断的偏头痛相关的心肌梗死和缺血性卒中风险增加不能用 NSAID 相关的心血管风险来解释。证据分类 本研究提供了 III 类证据，表明非甾体抗炎药相关的心血管风险无法解释偏头痛与心肌梗死或缺血性中风之间的关联。