Background: Preeclampsia (PEC) occurs in 3-8% of all pregnancies and doubles women’s long-term stroke risk. Prospective data are limited regarding the rate at which this risk develops. We hypothesized that history of PEC would increase risk of early stroke (ES), defined as stroke before age 60 without concurrent PEC, in women in the California Teachers Study (CTS), and that the risk would be modified by aspirin or statin use.
Methods: CTS participants aged ≤60 years with no prior stroke at time of enrollment in 1995 were included in this analysis. Baseline characteristics and medical and gynecological history were obtained by serial questionnaires. Participants were followed prospectively and stroke outcomes obtained via linkage with California hospital records through 12/31/2012. Poisson regression was used to calculate relative risk of ES incidence, among those with and without history of PEC, in unadjusted and adjusted models. We used stratified analyses to assess risk of ES in women with and without self-reported use of aspirin and/or statins.
Results: Of the 60,817 women included in the analysis, 3734 (6.1%) had PEC. Incident ES occurred in 49 (1.3%) women in the PEC group and 430 (0.8%) in the non-PEC group. Risk of ES incidence was greater in women with PEC compared to non-PEC in unadjusted models (RR 1.7, 95%CI 1.3-2.3). Adjusting for age, hypertension, diabetes, migraine, and obesity, RR remained higher in the PEC group (RR 1.4, 95%CI 1.1-1.9). Stratified analyses showed that this risk was mitigated in women taking aspirin or statins (RR 1.3, 95%CI 0.8-2.1), but elevated in those not taking them (RR 1.5, 95%CI 1.02-2.3).
Conclusion: Women with prior PEC were 40% more likely than those without PEC to develop ES, even controlling for other risk factors. Women with a history of PEC should be considered high risk for ES. Randomized trials are needed to assess whether long-term use of aspirin and/or statins would benefit all women with a history of PEC.