When Ajovy and other similar drugs were emerging, there was a concern for people with underlying heart disease or risk factors for heart disease. CGRP dilates blood vessels. By blocking it, scientists were initially worried that vital organs, like the heart or brain, would not get adequate blood supply. This concern was somewhat eased by the results from a study of another CGRP inhibitor, erenumab. In this study, people with coronary artery disease who normally developed chest pain when exercising underwent an exercise stress test after receiving erenumab or a placebo. Results found no difference between the two groups in the time it took them to develop chest pain. Still, there have been no studies on the safety of fremanezumab-vfrm in people with significant heart disease. Tell your provider if you have a history of heart disease.