Combination of Genes and Migraines May Increase Stroke and Heart Disease in Women

Women in mid-life who possess a certain genetic polymorphism and migraines may be at increased risk for ischemic stroke and heart disease, according to recent findings from the Women's Health Study (WHS). The study, published online July 30 in Neurology, follows previous research targeting the genetic association between migraine with aura and heart disease in women. The gene, methylenetetrahydrofolate reductase (MTHFR) (the TT genotype), has been associated with three times the risk for cardiovascular disease (CVD), and four times the risk of stroke, when compared with individuals who did not have the gene variant or history of migraine.

According to first author Markus Schuerks, MD, from Brigham and Women's Hospital, in Boston, Massachusetts, "A couple of years ago, 1 of the first prospective studies showing that migraine with aura is associated with an increased risk for cardiovascular disease (ischemic stroke and MI) was published. So we wanted to further investigate this triangular association between migraine — in particular, migraine with aura — cardiovascular disease, and this MTHFR polymorphism." The researchers found that the TT genotype alone did not increase the risk for CVD, but the combination of the genotype combined with migraine with aura doubled that risk. Further results showed that women with migraine had twice the risk of heart disease, and those with the TT gene variant also had a greater risk for ischemic stroke, but not heart attack. The study also revealed that the TT genotype had a slightly protective effect against migraine with aura.

The associations are complicated, but the research identifies a definite link between women’s increased risk for overall and specific heart disease for those with the gene variant and migraine with aura.

Principal investigator Tobias Kurth, MD, ScD, also from Brigham and Women's Hospital says, "While it is too early to start testing young women with migraine with aura for this gene variant, more focused research will help us to understand these complex links and will help us to potentially develop preventive strategies.”

What the Study Means to Women

Heart disease prevention, especially in women, is an evolving area of research. Aside from the engaging in risk factor modification through diet, exercise and cholesterol management, special considerations regarding individual risk factors are valuable.

Aspirin and fish oils are shown to benefit women with low levels of HDL (good) cholesterol, elevated triglyceride levels, and a strong family history of premature heart disease. Recommendations should be guided by your family doctor. Hormone therapy may be detrimental, and decisions regarding hormone replacement therapy must be carefully scrutinized. Women are also more prone to metabolic syndrome during peri-menopause, making age and hormonal status an important area of awareness for our risk of heart disease. It’s important to take extra measures – manage stress, and take measures to control abdominal obesity, blood pressure, and diabetes.

The more we learn about individual health risks, including the role of genetics, the greater our chances of maintaining good health and quality of life for years to come.

Source: Neurology. 2008;71: 505-513.

Helpful Links:

Guidelines on Preventing Heart Disease in Women
Heart Attack Prevention Overview
Metabolic Syndrome
Your Genes are Not Your Fate – Dean Ornish