Medicare patients are not at greater risk for cardiovascular disease (CVD) when taking anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) for migraines, compared with onabotulinumtoxinA treatment, shows a cohort study. These results were reported by Seonkyeong Yang, PhD, of the University of Florida, Gainesville, and colleagues, in a manuscript published Tuesday online in JAMA Neurology. Due to the CGRP blockade, researchers expressed concerns about CVD risk in the use of mAbs targeting CGRP or its receptor (anti-CGRP mAbs) for migraine prevention. The purpose of this study was to investigate the incidence of CVD in Medicare beneficiaries with migraine who took either anti-CGRP-mAbs or onabotulinumtoxinA in the U.S. for treatment. Medicare claims from May 2018 through December 2020 were used in this retrospective, sequential cohort study. Data were analyzed between August and December 2023. Patients in this study included Medicare beneficiaries aged 18 years or older and did not have a history of myocardial infarction (MI), stroke, cluster headaches, malignant cancer or hospice service within 1-year prior to treatment. The primary outcome of this study was time to first MI or stroke. Secondary outcomes included hypertensive crisis, peripheral revascularization and Raynaud phenomenon. A total of 5,153 patients initiated anti-CGRP mAbs (mean age=57.8 years, 83.6% female) and 4,000 patients initiated onabotulinumtoxinA (mean age=61.9 years, 83.8% female). The composite CVD events risk was not higher in the anti-CGRP mAbs group (adjusted hazard ratio [aHR]=0.88, 95% confidence interval [CI]=0.44-1.77) compared with the onabotulinumtoxinA group, nor were the secondary outcomes: hypertensive crisis (aHR=0.46, 95% CI=0.14-1.55), peripheral revascularization (aHR=1.50, 95% CI=0.48-4.73) and Raynaud phenomenon (aHR=0.75, 95% CI=0.45-1.24). Overall, use of anti-CGRP mAbs for the treatment of migraines did not increase Medicare patients’ risk of CVD compared with patients who took onabotulinmtoxinA. Source: Yang S, Orlova Y, Park H, et al. Cardiovascular Safety of Anti-CGRP Monoclonal Antibodies in Older Adults or Adults With Disability With Migraine. JAMA Neurol. 2025 Jan 6 (Article in Press). Image Credit: InsideCreativeHouse – stock.adobe.com