Triptan initiation tied to higher risk of stroke and MI in patients with high-risk CV profile: JAMA

Against the above background, Christian Lund Petersen, Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark, and colleagues aimed to establish whether an association between triptans and ischemic events could be demonstrated using a self-controlled design because this type of design is robust to the previously mentioned type of confounding.

For this purpose, the researchers identified all people in nationwide Danish registries initiating triptans and all the ischemic events they experienced. A case-crossover design was used to estimate odd ratios (OR) for associations between the first-ever use of triptan and ischemic outcomes, comparing triptan exposure in the two weeks up to the event with four 2-week reference periods.

Individuals redeeming a prescription for any triptan and experiencing at least 1 of 3 predefined ischemic outcomes were included from the population of Denmark. No one was excluded.

The main outcomes included acute myocardial infarction, ischemic stroke, or nonspecified stroke.

The key findings of the study were as follows:

• 429 612 individuals (median age, 38 years; 75.8% female) were identified who redeemed a first prescription for a triptan in the study period.
• Of these patients, 0.003% had a myocardial infarction with the first triptan prescription in either a focal or referent window (odds ratio [OR], 3.3), 0.004% had ischemic stroke (OR, 3.2), and 0.008% had ischemic/nonspecified stroke (OR, 3.0).
• Case patients had a median age of approximately 60 years and had a high-risk cardiovascular profile.

"The results suggest that although triptans use may be associated with a short-term higher risk of stroke or myocardial infarction, this amounted to a very small number of patients initiating triptans," the research team wrote.

"Triptans are generally considered safe in patients with low cardiovascular risk, and our findings do not raise concern about triptan use in this population group," they concluded.

Reference:

Petersen CL, Hougaard A, Gaist D, Hallas J. Risk of Stroke and Myocardial Infarction Among Initiators of Triptans. JAMA Neurol. Published online February 05, 2024. doi:10.1001/jamaneurol.2023.5549