Association of Oral Triptans and Other Oral Migraine Treatments With Cardiovascular Outcomes in Patients With a History of Cardiovascular Conditions

OBJECTIVETo assess risk of major adverse cardiovascular events associated with acute antimigraine treatments in patients with preexisting cardiovascular conditions. PATIENTS AND METHODSIn this retrospective, longitudinal, observational cohort study, we examined data from the Mass General Brigham Research Patient Data Registry on adults who received one or more prescriptions for acute migraine (index date) between January 2006 and December 2020 and who had one or more diagnoses of a cardiovascular condition during 12 months prior to index date. Study endpoints were nonfatal myocardial infarction, nonfatal stroke, and in-facility all-cause mortality, assessed separately and together as a composite major adverse cardiovascular events-proxy endpoint. RESULTSPrescriptions were identified for 4016 oral triptans, 6084 opioids/butalbital, and 2021 NSAIDs. Hazard ratios (HRs) for major adverse cardiovascular events were 0.38 (95% CI: 0.22, 0.67; P=.001) comparing oral triptans with opioids/butalbital and 0.46 (95% CI: 0.29, 0.71; P<.001) with NSAIDs. There was no increased risk of nonfatal stroke comparing oral triptans with opioids/butalbital (HR 0.39; 95% CI 0.22, 0.69; P=.001) and with NSAIDs (HR 0.44; 95% CI 0.26, 0.76; P=.003). In a subgroup analysis of patients taking sumatriptan, HRs for major adverse cardiovascular events were 0.34 (95% CI: 0.21, 0.56; P<.001) when comparing oral sumatriptan with opioids/butalbital and 0.47 (95% CI: 0.28, 0.79; P=.004) with NSAIDs. CONCLUSIONSThe risk of adverse cardiovascular events observed with oral triptans is not greater than opioids/butalbital and NSAIDs in patients with migraine and preexisting cardiovascular conditions.