Framingham Data: Is a History of Preeclampsia a Risk Factor for Later-Life Stroke?
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
Population-based cohort study (secondary analysis of preexisting data)
Framingham Heart Study (1948 to 2016)
Women who were stroke free at enrollment
Minimum of 3 study visits
1 pregnancy before menopause, hysterectomy, or age 45 years
A history of preeclampsia
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
Incident stroke later in life
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 receiving cholesterol-lowering medications
Have lower cholesterol and higher diastolic blood pressure
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
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
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