Lipton RB, et al. - The researchers used the Framingham nonlaboratory cardiovascular (CV) events risk equation to determine the number of individuals with episodic migraine (EM) who were at elevated risk for a first cardiovascular disease (CVD) event in the next 10 years using data from the American Migraine Prevalence and Prevention Study. Furthermore, they extrapolated the findings to the US population to evaluate the scope of people with EM for whom triptan and ergot therapies could be problematic. The number of individuals displaying relative contraindications to triptans and ergots based on a high FRS included over 900,000 women and men, among people with EM in the US. This included more than half a million individuals with EM, not having a prior CV event, condition, and procedure (ECP).

• In this cross-sectional analysis, the researchers included data from respondents to the 2009 American Migraine Prevalence and Prevention (AMPP) Study questionnaire aged ≥22 who met criteria and headache day frequency for EM.
• Using the nonlaboratory Framingham CV disease risk score (FRS), ten-year, first CVD event risk was calculated.
• They collected variables via respondent self-report and included sex, age, height, and weight to calculate body mass index (BMI), smoking status, and the presence of hypertension and diabetes among other variables.
• They used standard FRS cut scores of ≥21 for women and ≥16 for men, which indicated a 30% or greater risk of a first CVD event in the next 10 years.
• They collected history of CV ECPs via self-report of ever having the ECP and for events and conditions that were diagnosed by a physician.
• For this study, they applied rates of positive ECPs and rates of high FRS to age and sex stratified estimates of the number of people with EM in the US derived from 2015 US Census data to estimate rates of both in the population.

• A total of 5227 women and 1496 men with EM were included in the AMPP Study analysis.
• The outcomes demonstrated that 69.5% of women and 73.4% of men had at least one CV risk factor from the FRS, 38.9% of women and 41.6% of men had ≥2 risk factors, and 18.6% of women and 19.1% of men had ≥3 risk factors.
• For those aged 22-39, the proportion of women with high FRS was 0%, 0.8% (95%CI: 0.5-1.2%) among 40- to 59-year-olds and 15.2% (95% CI: 13.3-17.4%) among the ≥60 age group.
• The corresponding proportions for men were 0, 7.3% (95% CI: 5.7-9.4%), and 53.0% (95% CI: 4.7-58.1%).
• The number of persons with EM and high FRS was 403,000 for women and 510,000 for men, projecting to a national US sample.
• Based on a prior CV ECP, a high FRS or both, the proportion of women and men at high risk for future CV events increased with age from 20-39 (women 4.5%, men 4.2%), 40-59 (women 11.8%, men 18.6%), and ≥60 (women 31.2%, men 61.8%).
• An estimated 141,000 men aged 40-59 and 187,000 aged ≥60 and 34,000 women aged 40-59 and 181,000 women aged ≥60 in the US population with EM did not undergo CV ECP.
• However, they were at increased risk for a future CV event within the next 10 years, based upon their FRS alone.