Preeclampsia linked to elevated risk for stroke
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Women with a history of preeclampsia had a greater risk for stroke later in life, according to a secondary analysis of data from the Framingham Heart Study.
“Preeclampsia can result in acute cerebrovascular complications, including stroke and intracranial vasculopathy, and has been associated with an increase in the risk of stroke in later life,” Adam de Havenon, MD, an assistant professor of neurology at the University of Utah, and colleagues wrote. “However, existing research has not fully accounted for time-varying midlife risk factors that could bias the association between preeclampsia and later-life stroke.”
de Havenon and colleagues analyzed data on 1,435 women who were enrolled in the Framingham Heart Study, a population-based cohort study of women aged 28 to 74 years that was conducted from 1948 to 2016. The analysis only included white participants, so the “results are not generalizable to other racial or ethnic groups,” according to de Havenon and colleagues. The demographics of the study were likely “a byproduct of what a town in eastern Massachusetts looked like in 1948,” de Havenon said, because “there are multiple Framingham cohorts spanning generations, and in the later generations there is much more diversity.” The main outcome measure was incident stroke later in life, and the primary exposure was the presence or absence of preeclampsia.
Among the study population, 169 women had a history of preeclampsia and 231 had a stroke during 41,422 person-years of follow up. After adjusting for age and time-varying vascular risk factors — including BP, cholesterol level, blood glucose level, smoking status and weight — de Havenon and colleagues found that women with a history of preeclampsia had a higher risk for stroke later in life vs. those without a history of preeclampsia (RR = 3.79; 95% CI, 1.24-11.6). They wrote that the association was only established when adjusting for vascular risk factors, and therefore “it is the interplay of increasing age and the accumulation of vascular risk factors that likely creates the association between preeclampsia and stroke.”
“The stroke events occurred at a mean of more than 3 decades after the exposure, suggesting that aggressive medical management of vascular risk factors during midlife has the potential to reduce the risk of stroke,” de Havenon and colleagues wrote.
They added that more research is needed to evaluate “the practical implications of this association, particularly regarding the implementation of additional monitoring of vascular health among women with a history of preeclampsia and the use of lower thresholds for medical and lifestyle interventions to improve vascular health.”
“The implications are that medical providers should pay careful attention to the development of vascular risk factors (hypertension, diabetes, etc.) in their female patients who have had preeclampsia and consider aggressive control of the vascular risk factors in midlife,” de Havenon told Healio Primary Care.
In a related editorial, Jamie Kitt, BM, BCh, MA, British Heart Foundation clinical research fellow and cardiology specialty registrar in the Radcliffe Department of Medicine at Oxford University, and colleagues also noted that because the link between preeclampsia and stroke was apparent only after adjusting for lifetime exposure to risks, “it is likely that preventive behaviors and control of risk factors could be used to significantly modify the excess risk of cerebrovascular disease among those who develop preeclampsia.”
“The associations between hypertensive pregnancy and later vascular diseases, such as stroke, are clear,” they wrote. “The onus is now on identifying ways to take advantage of this information and prevent future harmful vascular events.”
de Havenon noted that the research team is now conducting “prospective research on women who have had preeclampsia to better understand the pathways for how preeclampsia could affect stroke risk decades later in life” and investigating “if there are enduring changes in their blood vessels and in their brain cells.”
“Understanding the intermediate steps between preeclampsia at a young age and stroke at an older age will help determine how to effectively lower the risk of stroke for these women,” he said.
References:
- de Havenon A, et al. JAMA Netw Open. 2021;doi:10.1001/jamanetworkopen.2021.5077.
- Kitt J, et al. JAMA Netw Open. 2021;doi:10.1001/jamanetworkopen.2021.5364.