Preeclampsia increases risk for early stroke

Be careful out there. You doctor should be able to compare stroke risk from this to birth control pills.
https://www.healio.com/cardiology/stroke/news/online/%7B6a627033-ddc3-48c4-a86e-2c92d04666e8%7D/preeclampsia-increases-risk-for-early-stroke?

January 29, 2018

Eliza C. Miller

Women with prior preeclampsia had an increased risk for early stroke compared with those who did not have preeclampsia, and this risk appears to be mitigated by aspirin use, according to an abstract presented at the International Stroke Conference.

“This study reinforces that we need to be thinking of preeclampsia as a major cardiovascular risk factor in women, one that we should be asking all our patients about,” Eliza C. Miller, MD, assistant professor of neurology at Columbia University College of Physicians and Surgeons, told Cardiology Today. “Current cardiovascular risk scores such as the Framingham or Reynolds scores or the Pooled Cohort Equations do not incorporate obstetric history, so we may be missing high-risk women who would benefit from more intensive preventive therapy.”

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Researchers analyzed data from 83,790 women (median age, 44 years at time of enrollment) from the California Teachers Study with no prior stroke at the time of enrollment in 1995. In the cohort, 4.9% had a history of preeclampsia.

Serial questionnaires were used to collect information on baseline characteristics in addition to medical and gynecological history. Patients were followed up through 2015, which included a review of hospital records for stroke outcomes.

Incident early stroke occurred in 0.62% of women without a history of preeclampsia and 0.93% of women with a history of preeclampsia.

The risk for early stroke was higher in women with a history of preeclampsia compared with those without a history of preeclampsia in an unadjusted analysis (HR = 1.5; 95% CI, 1.1-2.1) and after adjusting for hypertension, age, race, smoking, diabetes and obesity (HR = 1.24; 95% CI, 0.87-1.7).

Among those with preeclampsia, women who were taking aspirin had no increased risk for early stroke (adjusted HR = 0.7; 95% CI, 0.32-1.5), and those who were not taking aspirin had an elevated risk (adjusted HR = 1.4; 95% CI, 1-2.1).

“The fact that the increased stroke risk was not seen in women who were taking aspirin is extremely interesting and has not been shown before to my knowledge,” Miller told Cardiology Today.

Further research is needed, with a major focus on women with a history of preeclampsia.

“The time has come for a randomized clinical trial looking at aspirin or other preventive therapies in women with a history of preeclampsia — particularly women with early, preterm preeclampsia which has been shown to be a particularly strong risk factor in prior studies,” Miller said. “Women with a history of preeclampsia already get put on low-dose aspirin in subsequent pregnancies to prevent recurrent preeclampsia. Maybe they should just be continued on it long term. There’s no way to know without a randomized trial. What we can be sure of is that these women need to see primary care doctors regularly and have their risk factors addressed. One of the saddest things I see in my practice is women coming in with a stroke in their 50s, having not seen a doctor since the last time they had preeclampsia 20 years prior, not realizing that they were at increased risk.” – by Darlene Dobkowski

Reference:

Miller EC, et al. Abstract 174. Presented at: International Stroke Conference; Jan. 23-26, 2018; Los Angeles.