Conventional vascular risk factors: Their role in the association between migraine and cardiovascular diseases

Introduction Migraine, in particular migraine with aura, has been found to be associated with cardiovascular disease. However, the role of conventional vascular risk factors in the association is still debated. The aim of the present review is to address the association between migraine and conventional cardiovascular risk factors as well as to address their possible role in the association between migraine and cardiovascular disease. Methods Data for this review were obtained through searches in multiple sources up to May 2014 using the terms “migraine” OR “headache” in combination with all the vascular risk factors of interest. Results Data about the possible association between migraine and high blood pressure values are heterogeneous, hindering any final conclusion. Data addressing the possible association between migraine and diabetes mellitus indicate the lack of any association or in some cases a negative association between the two conditions. The body of evidence on the role of dyslipidemia in migraineurs is relatively homogeneous and, with few exceptions, reports an association between migraine and an unfavorable lipid profile; however, the difference in lipid levels between migraineurs and non-migraineurs is small and its clinical implication unclear. Regarding obesity, a trend has been observed of increased risk of migraine with increasing obesity, especially in young patients, albeit in the midst of conflicting data. Evidence about the association between cigarette smoking and migraine mostly indicates that migraineurs are more commonly smokers than non-migraineurs. On the other hand, the majority of the available studies report less alcohol use in migraineurs than in non-migraineurs. Finally, many of the available studies suggest a more frequent family history of cardiovascular disease in migraineurs as compared to non-migraineurs. Since most of the studies that supported the association between migraine and cardiovascular disease adjusted the analyses for the presence of several vascular risk factors, they cannot entirely explain this association. Conclusions Based on the available reported data, it seems unlikely that the higher risk of cardiovascular disease in migraineurs is mediated by any single vascular risk factor. For this reason the role of specific interactions among risk factors with the contribution of genetic, environmental, personality and psychological factors should be appropriately investigated.

Download Full-text

Abstract WP179: Rate of Pulmonary Embolism After Cerebral Venous Thrombosis

Stroke ◽

10.1161/str.48.suppl_1.wp179 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Ava L Liberman ◽

Alexander E Merkler ◽

Gino Gialdini ◽

Michael P Lerario ◽

Steven R Messe ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Venous Thrombosis ◽

Vascular Risk Factors ◽

Emergency Department Visits ◽

Administrative Claims ◽

Cerebral Vein ◽

Vascular Risk ◽

Index Hospitalization ◽

Increased Risk

Introduction: Cerebral vein thrombosis (CVT) is associated with an increased risk of subsequent venous thromboembolism. It is unknown whether the risk of pulmonary embolism (PE) after CVT is similar to that of PE after deep venous thrombosis (DVT). Methods: We performed a retrospective cohort study using administrative claims data from all emergency department visits and hospitalizations in California from 2005-2011, New York from 2006-2013, and Florida from 2005-2013. We identified patients with CVT or DVT as well as the primary outcome of PE using previously validated International Classification of Diseases, Ninth Revision, Clinical Modification ( ICD-9-CM ) codes. In order to minimize misclassification error, patients with both CVT and DVT during the same index hospitalization were excluded and patients with CVT were censored at the time of development of DVT and vice versa. Kaplan-Meier survival statistics and Cox proportional hazards models were used to compare the risk of PE after CVT versus after DVT while adjusting for demographics, vascular risk factors, and the Elixhauser comorbidity index. Results: We identified 4,450 patients with CVT and 217,589 patients with DVT. During a mean follow-up of 2.0 (±1.7) years, 124 patients with DVT developed a PE and 18,698 patients with DVT developed a PE. Patients with CVT were younger (mean age 45 vs 63), more often female (71% vs 52%), more often pregnant, and had fewer vascular risk factors than patients with DVT. During the index hospitalization, the rate of PE was 1.5% (95% confidence interval [CI], 1.1-1.8%) in patients with CVT and 6.2% (95% CI, 6.1-6.3%, p<0.001) in patients with DVT. By 5 years, the cumulative rate of PE after CVT was 3.7% (95% CI, 3.0-4.4%) compared to 10.5% (95% CI, 10.3-10.6%, p<0.001) after DVT. After adjustment for demographics and comorbidities, CVT was associated with a significantly lower hazard of PE when compared to DVT (hazard ratio, 0.31; 95% CI, 0.26-0.38). Conclusion: In a large, heterogeneous population, we found that the risk of PE after CVT was significantly lower than that of PE after DVT. Among patients with CVT, the greatest risk for PE was apparent during the index hospitalization.

Download Full-text

Association between Risk Factors for Vascular Dementia and Adiponectin

BioMed Research International ◽

10.1155/2014/261672 ◽

2014 ◽

Vol 2014 ◽

pp. 1-13 ◽

Cited By ~ 17

Author(s):

Juhyun Song ◽

Won Taek Lee ◽

Kyung Ah Park ◽

Jong Eun Lee

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Signal Transduction ◽

Vascular Dementia ◽

Case Control ◽

Case Control Studies ◽

Insulin Signal Transduction ◽

Increased Risk ◽

The Brain

Vascular dementia is caused by various factors, including increased age, diabetes, hypertension, atherosclerosis, and stroke. Adiponectin is an adipokine secreted by adipose tissue. Adiponectin is widely known as a regulating factor related to cardiovascular disease and diabetes. Adiponectin plasma levels decrease with age. Decreased adiponectin increases the risk of cardiovascular disease and diabetes. Adiponectin improves hypertension and atherosclerosis by acting as a vasodilator and antiatherogenic factor. Moreover, adiponectin is involved in cognitive dysfunction via modulation of insulin signal transduction in the brain. Case-control studies demonstrate the association between low adiponectin and increased risk of stroke, hypertension, and diabetes. This review summarizes the recent findings on the association between risk factors for vascular dementia and adiponectin. To emphasize this relationship, we will discuss the importance of research regarding the role of adiponectin in vascular dementia.

Download Full-text

NCMP-06. THE RISK AND BURDEN OF THROMBOEMBOLIC AND HEMORRHAGIC EVENTS IN PATIENTS WITH MALIGNANT GLIOMA RECEIVING BEVACIZUMAB

Neuro-Oncology ◽

10.1093/neuonc/noab196.579 ◽

2021 ◽

Vol 23 (Supplement_6) ◽

pp. vi148-vi148

Author(s):

Alexander Ou ◽

Heather Lin ◽

Ying Yuan ◽

Charles Bornstein ◽

Kristin Alfaro-Munoz ◽

...

Keyword(s):

Risk Factors ◽

Performance Status ◽

Univariate Analysis ◽

Vascular Complications ◽

Concurrent Chemotherapy ◽

Vascular Risk Factors ◽

Competing Risk ◽

Vascular Risk ◽

Acute Hemorrhage ◽

Increased Risk

Abstract BACKGROUND Patients with high-grade gliomas (HGG) often receive anti-angiogenic therapy with bevacizumab to slow disease progression and/or palliate neurological symptoms. Bevacizumab has been associated with an increased risk of two major vascular complications: venous thromboembolism (VTE) and intracranial hemorrhage (ICH). We sought to identify clinical, pathologic, and radiographic variables correlated with risk of either event occurring in patients with HGG receiving bevacizumab. METHODS We retrospectively identified 94 patients with HGG who received bevacizumab at our center from 2015-2021. Variables included demographics, performance status, IDH, MGMT, vascular risk factors, baseline anti-coagulant/anti-platelet use, concurrent chemotherapy, and presence of macrobleeds on MRI (>1 cm3 susceptibility) at the time of bevacizumab initiation. We conducted competing risk analysis using subdistribution hazard models with death as competing risk for ICH or VTE. The effects of covariates on the incidence of hemorrhage or VTE were evaluated in univariate and multivariate settings. RESULTS Of 94 patients, 36 (38.3%) and 27 (28.7%) developed VTE and ICH, respectively. 31 (33%) did not develop either. ICH and VTE events occurred after a mean of 4.46 and 5.94 cycles of bevacizumab, respectively. 20 had baseline anti-platelet/anticoagulant use, and 16 had prior VTEs. Patients with macrobleeds on MRI had a larger HR of developing acute hemorrhage [HR=2.368 (1.112, 5.043), p=0.0254]. Patients older than 50 trended toward larger HR of developing VTE in univariate analysis that approached significance [HR=1.799 (0.889, 3.637), p=0.1023]. Sex, performance status, IDH, MGMT, vascular risk factors, baseline anticoagulant/anti-platelet use and concurrent chemotherapy were not significantly associated with occurrence of VTE. CONCLUSIONS The presence of macrobleeds on MRI is associated with increased risk of developing acute ICH while on bevacizumab. Older age at diagnosis of HGG may be associated with an increased risk of VTE in patients receiving bevacizumab. Larger studies are needed to confirm these findings.

Download Full-text

Abstract WP116: Patterns of Vascular Calcification in Young Patients With Intracranial Stenosis

Stroke ◽

10.1161/str.47.suppl_1.wp116 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Tamara Strohm ◽

Irene Katzan ◽

Ken Uchino

Keyword(s):

Risk Factors ◽

Vascular Calcification ◽

Young Patients ◽

Vascular Risk Factors ◽

Intracranial Stenosis ◽

Intracranial Calcification ◽

Vascular Risk ◽

Atherosclerotic Stenosis ◽

Significant Difference ◽

Determine Mechanism

Introduction: Intravascular calcification is thought to be a marker of atherosclerosis in patients with stenosis and vascular risk factors. Little is known about the utility of quantifying intracranial calcification to help determine mechanism of stenosis. The objective of our study was to compare presence and patterns of intracranial calcification in patients with intracranial stenosis due to atherosclerosis and other etiologies. Methods: Retrospective cohort study of 89 patients < 50 years with diagnosis of intracranial stenosis who had undergone CT angiogram from 2008-2013; 44 had presumed atherosclerosis as etiology ( > 3 vascular risk factors with no other identified cause). CTAs were reviewed for presence and location of intracranial calcification. Results: Of patients with atherosclerotic stenosis, 28 (64%) had intravascular calcification compared to 16 (36%) of those with stenosis of other etiologies (P=0.0039). There was no significant difference in pattern or location of stenosis between groups. One-third had calcification outside the region of stenosis in both groups. Distal internal carotid artery and distal vertebral artery were the most common sites of intracranial calcification (Table). Conclusion: Intracranial calcification is more commonly seen in patients < 50 years old with stenosis secondary to atherosclerosis, but the pattern and location was similar between groups. More research is needed to determine the utility of using the presence of vascular calcification to help determine mechanism of intracranial stenosis in the young.

Download Full-text

Vascular Events, Vascular Disease and Vascular Risk Factors—Strongly Intertwined with COVID-19

Current Treatment Options in Neurology ◽

10.1007/s11940-020-00648-y ◽

2020 ◽

Vol 22 (11) ◽

Author(s):

Adrian Scutelnic ◽

Mirjam R. Heldner

Keyword(s):

Risk Factors ◽

Vascular Disease ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Vascular Events ◽

Increased Risk ◽

Clinical Benefits ◽

Infection And Inflammation ◽

Unhealthy Diet ◽

New Perspective

Abstract Purpose of review To elucidate the intertwining of vascular events, vascular disease and vascular risk factors and COVID-19. Recent findings Strokes are a leading cause of disability and death worldwide. Vascular risk factors are important drivers of strokes. There are unmodifiable vascular risk factors such as age and ethnicity and modifiable vascular risk factors. According to the INTERSTROKE study, the 10 most frequent modifiable vascular risk factors are arterial hypertension, physical inactivity, overweight, dyslipidaemia, smoking, unhealthy diet, cardiac pathologies, diabetes mellitus, stress/depression and overconsumption of alcohol. Also, infection and inflammation have been shown to increase the risk of stroke. There is high-quality evidence for the clinical benefits of optimal primary and secondary stroke prevention. The COVID-19 pandemic brought a new perspective to this field. Vascular events, vascular disease and vascular risk factors—and COVID-19—are strongly intertwined. An increased risk of vascular events—by multifactorial mechanisms—has been observed in COVID-19 patients. Also, a higher rate of infection with COVID-19, severe COVID-19 and bad outcome has been demonstrated in patients with pre-existing vascular disease and vascular risk factors. Summary At present, we suggest that regular interactions between healthcare professionals and patients should include education on COVID-19 and on primary and secondary vascular prevention in order to reduce the burden of disease in our ageing populations.

Download Full-text