To determine whether hypertensive disorders of pregnancy (HDP) increased long-term stroke risk in women in the California Teachers Study (CTS), a prospective cohort study, and whether aspirin or statin use modified this risk.MethodsCTS participants ≤60 years of age at the time of enrollment in 1995 were followed up prospectively for validated stroke outcomes obtained via linkage with California hospital records through December 31, 2015. We calculated unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the primary outcomes of all stroke and stroke before 60 years of age among those with and without a history of HDP. We tested for interactions (p < 0.2) and performed stratified analyses to assess the risk of the primary outcomes in women with and without self-reported use of aspirin or statins.ResultsOf 83,749 women included in the analysis, 4,070 (4.9%) had HDP. Women with prior HDP had increased risk of all stroke (adjusted HR 1.3, 95% CI 1.2-1.4) but no increased risk of stroke before age 60 (adjusted HR 1.2, 95% CI 0.9-1.7). There was an interaction (p = 0.18) between aspirin use and HDP history on risk of stroke before age 60: nonusers of aspirin had higher risk (adjusted HR 1.5, 95% CI 1.0-2.1) while aspirin users did not (adjusted HR 0.8, 95% CI 0.4-1.7). This effect was not seen with statins.ConclusionsAfter controlling for comorbid conditions, women with prior HDP had increased long-term stroke risk, which was reduced by aspirin use. Randomized trials may be needed to assess whether long-term aspirin use could benefit selected women with a history of HDP.
Bibliographical noteFunding Information:
Dr. Miller received research support from the NIH National Institute of Neurological Disorders and Stroke StrokeNet Training Core (U10NS08672805) and the NIH National Center for Advancing Translational Sciences 5KL2TR001874- 02. Dr. Boehme received support through NIH National Institute of Neurological Disorders and Stroke R03 NS101417 and NIH National Institute of Minority Health and Health Disparities R21 MD012451. Dr. Bello is supported by the NIH National Center for Advancing Translational Sciences 5KL2TR001874-02 and the American College of Cardiology. Dr. Wapner receives support from the NuMoM2b-Heart Health Study (NIH National Heart, Lung, and Blood Institute 5U10HL119992-03) for work related to long-term cardiovascular outcomes after pregnancy. Stroke validation in the CTS was supported by the NIH National Institute of Neurological Disorders and Stroke to Dr. Wang (R21NS075608), the National Cancer Institute (R01CA077398, K05CA136967), and the Beckman Research Institute of the City of Hope. The CTS data infrastructure that makes analyses possible is supported by the NIH National Cancer Institute to Dr. Lacey (U01CA188277).
© 2019 American Academy of Neurology.
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