medwireNews: Triptan use for migraines may be associated with a small short-term increased risk for myocardial infarction (MI) and ischemic stroke, but this primarily occurs in patients with high a cardiovascular (CV) risk profile, shows a case-crossover study.
Jesper Hallas (Odense University Hospital, Denmark) and colleagues identified 429,612 individuals (median age 38 years, 76% women) from Danish registries who had initiated triptans between 1995 and 2022 and had one of three outcomes.
In all, 11 (0.003%) individuals had an MI after initiating triptans, 18 (0.004%) had an ischemic stroke, and 35 (0.008%) had an ischemic or nonspecified stroke.
The researchers comment in JAMA Neurology that the very low case numbers are important, since this “testifies to the low absolute risk among initiators [of triptans].”
Compared with the triptan users who did not have an ischemic event, participants who did had more cardiovascular risk factors, particularly hypertension (50.0 vs 10.4%) and were more likely to be older than 60 years (48.0 vs 7.1%), they note.
Hallas and authors assessed the likelihood that the individuals who had an ischemic event were taking triptans in the preceding 14 weeks, compared with at four other consecutive reference windows.
They found that the patients who had an MI were a significant 3.3 times more likely to be taking triptans 14 weeks prior to the event than at the other times. And the likelihood was significantly higher among individuals who had hypertension (odds ratio [OR]=4.0), a previous acute coronary syndrome (OR=5.3), or who were younger than 60 years old (OR=6.0).
Among those who had an ischemic stroke, the use of triptans in the preceding 14 weeks was a significant 3.2 times more likely than at the other times, with the odds again significantly increased among individuals with hypertension (OR=4.0) and those younger than 60 years old (OR=5.3), but also in men (OR=8.0).
The participants who had ischemic or unspecified stroke were a significant three times more likely to be taking triptans in the 14 weeks prior, and the odds were higher for men (OR=8.0) and those with diabetes (OR=16.0). In contrast to the other outcome groups, the likelihood was similarly high for both participants younger than 60 years (OR=3.1) and those 60 years and older (OR=2.9).
The investigators caution, however, that the subgroups “involved very low numbers of patients for all outcomes.”
They also note that triptans may have been inadvertently prescribed for migraines as a primary manifestation of a cerebrovascular event and so there is the possibility of protopathic bias.
The team concludes that the results “support the US Food and Drug Administration recommendation that triptans should not be prescribed to patients with a history of coronary artery disease, transient ischemic attack or stroke.”
However, they believe that “[t]riptans are generally considered safe in patients with low cardiovascular risk, and our findings do not raise concern about triptan use in this population group.”
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