Neurological

Preeclampsia can be a risk factor for stroke later in life

After adjusting for time-varying covariates, preeclampsia may be an independent risk factor for stroke later in life in women who have had one or more pregnancies, according to the results of the secondary analysis of the Framingham Heart Study published on JAMA Network Open.

A team of researchers conducted a population-based cohort study to determine whether a history of preeclampsia affects the relative risk of stroke, after considering time-varying covariates. They did this using marginal structural models.

Study investigators included women with one or more pregnancies who were stroke-free at the time of admission, had at least 3 study visits, and at least 1 pregnancy before menopause, hysterectomy, or at the age of 45 years. The main outcome of the study was the incidence of stroke later in life.

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Of the 1,435 women enrolled in the Framingham Heart Study (mean age 44.4 years; cumulative observation 51,600 person-years), 169 women (11.8%) had a history of preeclampsia. A stroke occurred in 231 women (16.1%) and on average 32.4 years after the start of the study. The study researchers observed stroke events in 30 of 169 women (17.8%) and 201 of 1266 women (15.9%) with and without a history of preeclampsia.

At baseline, women with a history of preeclampsia were more likely to be younger, were receiving treatment for hyperlipidemia, were currently smoking, had lower serum total cholesterol levels, and had higher diastolic blood pressure compared to women with no history of preeclampsia.

At the last exam, women with a history of preeclampsia were more likely to have higher blood sugar and lower phospholipid levels. They were more likely to receive treatment for hyperlipidemia and hypertension than women who had no history of preeclampsia.

The marginal structural model only established a relationship between preeclampsia and stroke if adjustments were made for all vascular risk factors over the course of life. After this adjustment, women with a history of preeclampsia had a relative risk of 3.79 for stroke later in life compared to women without such a history.

“Future research is warranted to fully examine the mediation of this association through vascular risk factors in midlife,” the study researchers concluded.

Disclosure: Several authors stated links to the pharmaceutical industry. For a full list of the details, see the original article.

reference

de Havenon A, Delic A, Stulberg E, et al. Association of Preeclampsia with Later Life Stroke in Women in the Framingham Heart Study. JAMA network open. 2021; 4 (4): e215077. doi: 10.1001 / jamanetworkopen.2021.5077

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