LOS ANGELES—Women with a history of preeclampsia have a significantly increased risk for early-onset stroke, but that risk is reduced in women taking aspirin, according to research described at the International Stroke Conference 2018.
The results came from an epidemiologic analysis of data for 83,790 women in the California Teachers Study. Among the 4,072 women with a history of preeclampsia, 3,003 were not on aspirin. During follow-up, these women had an incidence of ischemic and hemorrhagic stroke before age 60 of greater than 1%. Their incidence rate was 40% higher than that of the approximately 60,000 women without a history of preeclampsia who were not taking aspirin. The difference between groups remained statistically significant after the researchers adjusted the data for demographics, smoking, obesity, diabetes, and hypertension, said Eliza C. Miller, MD, a vascular neurologist at Columbia University in New York.
The findings suggest that an aspirin prevention trial in women at high risk for stroke, such as women with a history of preeclampsia, is warranted, said Dr. Miller. Cardiovascular risk prediction models such as the Framingham Risk Score could be modified to account for a history of preeclampsia, she added.
Dr. Miller’s analysis focused on women who entered the California Teachers Study when they were younger than 60, had no history of stroke, and provided data on their history of preeclampsia. The prevalence of a history of preeclampsia was 4.9% overall and 6.1% among women who had been pregnant at least once. This incidence rate was similar to those of other large populations of women, said Dr. Miller.
The average age was 44 among women with preeclampsia and 46 among women without preeclampsia. Women with a history of preeclampsia also had higher prevalence rates of obesity, hypertension, diabetes, and chronic kidney disease. About a quarter of all women regularly took aspirin.
After data adjustment, women with a history of preeclampsia had a 20% higher overall rate of stroke before age 60. The difference between groups was not significant in an analysis that included women taking aspirin and those not taking it. When the analysis examined only women not taking aspirin, the stroke rate in women with a history of preeclampsia was 40% higher than that in women without a history of preeclampsia, a statistically significant difference. In contrast, among women taking aspirin, women with and without a history of preeclampsia had similar rates of stroke.
—Mitchel L. Zoler