Conference Coverage

Aspirin blunts early stroke risk from preeclampsia



– Women with a history of preeclampsia have a significantly increased risk for an early-onset stroke, but that risk is blunted in women taking aspirin, an epidemiologic analysis of data from more than 83,000 women in the California Teachers Study showed.

Among the 4,072 women in the study with a history of preeclampsia, 3,003 were not on aspirin, and during follow-up they had a greater than 1% incidence of stroke – ischemic and hemorrhagic combined – before turning 60 years of age. Their incidence rate was 40% higher than in the roughly 60,000 women without a preeclampsia history who were not taking aspirin, a statistically significant difference after adjustment for demographics, smoking, obesity, diabetes, and hypertension, Eliza C. Miller, MD, said at the International Stroke Conference, sponsored by the American Heart Association.

International Stroke Conference Meeting Sign Mitchel L. Zoler/Frontline Medical News
The findings suggest that it’s time to run an aspirin prevention trial in women at high risk for stroke, such as women with a history of preeclampsia, said Dr. Miller, a vascular neurologist at Columbia University in New York. Results from a randomized multicenter trial with more than 1,600 women reported in 2017 showed that treatment with aspirin could reduce the incidence of preeclampsia during pregnancy (N Engl J Med. 2017 Aug 17;377[7]:613-22), but no reported study has assessed the impact of aspirin prophylaxis for stroke prevention following preeclampsia. She also raised the possibility of modifying cardiovascular risk prediction models, such as the Framingham Risk Score, so they take into account a history of preeclampsia.

Her analysis used data drawn from more than 133,000 women enrolled starting in 1995 in the California Teachers Study. She focused on 83,790 women who entered the study when they were younger than 60 years old, who had no history of stroke, and who provided data on their history of preeclampsia. The prevalence of a preeclampsia history was 4.9% overall, and 6.1% among women who had been pregnant at least once, an incidence rate similar to what has been found in other large populations of women, Dr. Miller said.

The average age of the women with preeclampsia was 44, and 46 for those without preeclampsia. The women with a history of preeclampsia also had a higher prevalence rate of obesity, hypertension, diabetes, and chronic kidney disease. Roughly a quarter of all women were regularly taking aspirin.

After adjustment of the data for demographic and clinical differences, women with a history of preeclampsia had a 20% higher overall rate of a subsequent stroke before reaching age 60 years, but this difference was not significant in an analysis that included both women taking aspirin and those not on the drug. When the analysis focused only on the women not on aspirin, the increased stroke rate linked with a preeclampsia history rose to 40% higher than in women without a preeclampsia history, a statistically significant difference. In contrast, among the quarter of women on aspirin, the two subgroups – with a preeclampsia history and without – had similar rates of incident strokes.

SOURCE: Miller E et al. International Stroke Conference 2018, A174 (Stroke. 2018 Jan;49[Suppl1]:A174).

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