BACKGROUND AND PURPOSE:

• Previous research has only partially assessed time-varying midlife risk factors that could lead to bias when determining the association between preeclampsia and later-life stroke
• de Havenon et al. (JAMA Network Open, 2021) assessed the risk of stroke in later life among women with and without a history of preeclampsia, with a focus on analyzing time-varying covariates  

METHODS:

• Population-based cohort study (secondary analysis of preexisting data)
• Data source
  • Framingham Heart Study (1948 to 2016)
• Population
  • Women who were stroke free at enrollment
  • Minimum of 3 study visits
  • 1 pregnancy before menopause, hysterectomy, or age 45 years
• Exposure
  • A history of preeclampsia
• Study design
  • Data on vascular risk factors, history of preeclampsia, and stroke incidence were collected biannually
  • Participants were followed up until incident stroke or censorship from the study
  • The relative risk of incident stroke was calculated with and without a history of preeclampsia after adjusting for time-dependent covariates at each study visit
  • Time-dependent covariates: BP | Blood glucose level | Lipid levels | Current smoking status (yes or no) | Weight | Age
• Primary outcome
  • Incident stroke later in life

RESULTS:

• 1435 women | 41,422 person-years of follow-up
  • Mean age 44.4: years; 100% White
  • History of preeclampsia: 169 women
  • Experience stroke during follow-up: 231 women
• At baseline, women with preeclampsia were more likely to
  • Be younger
  • Be receiving cholesterol-lowering medications
  • Have lower cholesterol and higher diastolic blood pressure
  • Currently smoke
• Women with a history of preeclampsia had a higher risk of stroke in later life compared with women without a history of preeclampsia
  • Relative risk 3.79 (95% CI, 1.24 to 11.60)
  • The association between preeclampsia and stroke was only evident when adjustment was made for all vascular risk factors over the life course

CONCLUSION:

• After adjusting for demographic and vascular factors which vary over time, women with a history of preeclampsia still had a higher risk of later-life stroke
• The authors note several limitations, including self-reporting of preeclampsia and lack of generalizability due to population studied
• The authors conclude

 In this cohort study, White women with a history of preeclampsia had more than 3 times the risk of later-life stroke compared with those without a history of preeclampsia

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 

Learn More – Primary Sources:

Association of Preeclampsia With Incident Stroke in Later Life Among Women in the Framingham Heart Study

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