Background: Preeclampsia is an under recognized risk factor for vascular disease. Women with preeclampsia are at higher risk for ischemic cardiovascular and cerebrovascular events later in life. It is currently unknown if this risk also applies to hemorrhagic stroke. We here investigate the risk of non-pregnancy related intracerebral hemorrhage (ICH) in women with a history of preeclampsia. Our hypothesis was that a history of preeclampsia confers an increased risk of ICH in later life.
Method: ERICH is a multi-center, prospective, case-control study of a racial-ethnically mixed population with ICH. Controls were identified through random digit dialing to match cases by age (+/- 5 years), sex, race/ethnicity (non-Hispanic white, non-Hispanic black and Hispanic) and geographic area. An obstetric history was obtained in all women with ICH and their controls. Pre-eclampsia was defined as: 1) Having been told to have had toxemia, pre-eclampsia or eclampsia or 2) having had high blood pressure and protein in the urine during any pregnancy. Odds ratios (OR) for preeclampsia were calculated in cases and controls. We also compared baseline demographics and ICH characteristics of women with and without a history of preeclampsia.
Results: A total of 685 cases were matched to controls. Mean age was 65 years and hypertension was more prevalent in cases (76% vs. 47%, p <.0001). A history of preeclampsia was noted in 6% of controls and 7% of cases with an OR of 1.20 (0.77-1.88, p=0.425). In a case-case comparison, women with ICH and a history or preeclampsia were more likely to be younger (55±14 vs. 66±14 years, p<.0001) and hypertensive (93% vs. 83%, p=.0387). After adjusting for other baseline differences women with ICH and preeclampsia history remained significantly younger than those with no history of preeclampsia.
Conclusion: Despite associations of pre-eclampsia with ischemic cardiovascular and cerebrovascular events later in life, we found no association of an increased risk of spontaneous ICH. Women with ICH and a history of pre-eclampsia, however, were more likely to have an ICH at a younger age, by nearly a decade, after controlling for all other variables. Women with preeclampsia may be a suitable target for interventions to prevent early life ICH.