Cardiovascular Riskprofile in Women: Microvascular Status

Current cardiovascular risk prediction models are likely to underestimate risk
when applied to young women. Probably, this is due to the failure to
acknowledge risk factors exclusive to women, such as pregnancy-related changes
and a different impact of risk factors that are not gender-specific, such as
smoking and obesity. An important example of female-specific cardiovascular
features is migraine, which occurs three times more often in women compared to
men and is associated with a twofold increased risk of ischemic stroke. The
association between migraine and cardiovascular disease has been demonstrated
in several large studies. A growing number of studies also show associations
between migraine and increased risk for pregnancy-related vascular events such
as gestational hypertension and preeclampsia (PE). It remains unclear to what
extent female-specific risk factors, including polycystic ovary syndrome
(PCOS), primary ovarian insufficiency (POI) and PE, interact with migraine to
have a synergistic effect on cardiovascular disease (CVD) outcome. It is
suggested that signs and symptoms of cardiovascular disease in women are
related to microvascular ischemia and endothelial dysfunction, more so than in
men. In both women with preeclampsia and women with migraine a higher risk for
the presence of white matter hyperintensities on brain MRI have been found as a
possible indication of vascular damage.

To gain further insight into the interaction and possibly shared
pathophysiological mechanisms of female-specific cardiovascular risk factors
and events we will quantify white matter hyperintensities on brain MRI and
assess endothelial function in selected groups of young women with and without
migraine and a history of stroke or reproductive disorder.

Observational multicentre case-control study.

Risks of MRI: none documented. Risks of LTH and LDPI: none documented. Risks of
EndoPAT: none documented. Risks of venipuncture: mild pain and bruising

The burden for participants will consist of a visit of 30 minutes for the MRI
brain or 130 minutes for the MRI of the brain combined with endothelial
function measurements. It is possible that mild discomfort will be experienced
during inflation of blood pressure cuff lasting for five minutes. Furthermore a
venipuncture will be performed for blood withdrawal which may lead to pain
and/or bruising.

Participation does not hold benefits for the participants. In the case of high
quantity of white matter hyperintensities or severe endothelial dysfunction the
general practitioner will be requested to screen for possible cardiovascular
risk factors. However it is uncertain if this is a potential benefit for the
participant.