ImportanceTriptans are contraindicated in patients with ischemic heart disease or previous myocardial infarction, and caution is advised when prescribing these drugs to patients with vascular risk factors. However, controlled observational studies have either shown no association or an apparent lower risk, possibly owing to a channeling of triptans to individuals at low risk of cardiovascular outcomes, and it remains unclear whether avoiding triptan treatment for these patients is meaningful.ObjectiveTo 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.Design, Setting, and ParticipantsAll people in nationwide Danish registries who were initiating triptans and all the ischemic events that they experienced were identified. A case-crossover design was used to estimate odds ratios (OR) for associations between first-ever triptan use and ischemic outcomes, comparing triptan exposure in the 2-week period up to the event with four 2-week reference periods. Data were obtained for the period January 1995 to August 2022. Included from the population of Denmark were individuals redeeming a prescription for any triptan and experiencing at least 1 of 3 predefined ischemic outcomes. No one was excluded.ExposureInitiation of any triptan.Main Outcomes and MeasuresAcute myocardial infarction, ischemic stroke, or nonspecified stroke.ResultsIdentified were a total of 429 612 individuals (median [IQR] age, 38 [28-48] years; 325 687 female [75.8%]) who redeemed a first prescription for a triptan in the study period. Of these patients, 11 (0.003%) had a myocardial infarction with the first triptan prescription in either a focal or referent window (odds ratio [OR], 3.3; 95% CI, 1.0-10.9), 18 (0.004%) had ischemic stroke (OR, 3.2; 95% CI, 1.3-8.1), and 35 (0.008%) had ischemic/nonspecified stroke (OR, 3.0; 95% CI, 1.5-5.9). Case patients had a median age of approximately 60 years and had a high-risk cardiovascular profile.Conclusions and RelevanceResults of this case-crossover study suggest that triptan initiation was associated with higher risk of ischemic stroke and myocardial infarction. For the individual patient with low background cardiovascular risk, the risk of an ischemic event after triptan initiation was very low.

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曲坦类药物起始者中风和心肌梗塞的风险

重要性 患有缺血性心脏病或既往心肌梗死的患者禁用曲普坦类药物，建议在给有血管危险因素的患者开这些药物时要小心。然而，对照观察性研究要么显示没有关联，要么显示风险明显较低，这可能是由于曲坦类药物被引导至心血管结局风险较低的个体，目前尚不清楚对这些患者避免曲坦类治疗是否有意义。曲坦类药物和缺血事件之间的关联可以使用自控设计来证明，因为这种类型的设计对于前面提到的混杂类型具有鲁棒性。设计、设置和参与者丹麦全国登记处所有开始使用曲坦类药物和所有缺血事件的人他们所经历的事情被识别出来。采用病例交叉设计来估计首次使用曲坦类药物与缺血结局之间关联的比值比 (OR)，将事件发生前 2 周内的曲坦类暴露量与四个 2 周参考期进行比较。数据获取时间为 1995 年 1 月至 2022 年 8 月。丹麦人口中包括兑换任何曲坦类处方且经历 3 种预定缺血结果中至少 1 种的个人。没有人被排除。暴露开始任何曲坦类药物。主要结果和措施急性心肌梗塞、缺血性中风或非特定中风。结果总共识别出 429 612 名个体（中位 [IQR] 年龄，38 [28-48] 岁；325 687 名女性[75.8%]）在研究期间兑换了曲坦类药物的第一个处方。在这些患者中，11 名 (0.003%) 患者在局灶性或参考窗口首次服用曲坦类药物时出现心肌梗死（优势比 [OR]，3.3；95% CI，1.0-10.9），18 名 (0.004%) 患有缺血性心肌梗死中风（OR，3.2；95% CI，1.3-8.1），35 名（0.008%）患有缺血性/非特异性中风（OR，3.0；95% CI，1.5-5.9）。病例患者的中位年龄约为 60 岁，具有高风险心血管特征。结论和相关性这项病例交叉研究的结果表明，开始服用曲普坦与缺血性中风和心肌梗死的较高风险相关。对于背景心血管风险较低的个体患者，曲坦类药物治疗后发生缺血事件的风险非常低。