Aspirin lowers stroke risk after hypertensive disorders of pregnancy

  • Miller EC & al.
  • Neurology
  • 26 Dec 2018

  • curated by Susan London
  • Clinical Essentials
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Takeaway

  • Women having a history of hypertensive disorders of pregnancy (HDP) were less likely to experience a stroke before age 60 if they reported regularly using aspirin.

Why this matters

Key results

  • 4.9% of cohort had HDP history (self-reported preeclampsia or hospital-diagnosed gestational hypertension, preeclampsia, eclampsia).
  • Vs unaffected peers, women with prior HDP had:
    • Increased risk for any stroke (adjusted HR [aHR], 1.3; 95% CI, 1.2-1.4);
    • Similar risk for stroke before age 60 (aHR, 1.2; 95% CI, 0.9-1.7).
  • Interaction between aspirin use, HDP history for stroke before age 60 (P=.18).
  • For women with HDP history, risk for stroke before age 60:
    • Elevated for aspirin nonusers (aHR, 1.5; 95% CI, 1.0-2.1);
    • Not elevated for aspirin users (aHR, 0.8; 95% CI, 0.4-1.7).
  • Stroke risks overall, before age 60 not significantly affected by statin use.

Expert comment

  • In an editorial, Dr. Steven K. Feske and Dr. Cheryl Bushnell write, “The findings here are too preliminary to drive clinical decision making. However, taking the findings of the Women’s Health Study into consideration, the use of aspirin for primary prevention in women >45 years of age is reasonable, increasingly so as they accumulate risk factors.”

Study design

  • Prospective cohort study of 83,749 female teachers ≤60 years of age at enrollment with median follow-up of ~18 years.
  • Main outcomes: stroke overall, stroke before age 60; from linked hospital records.
  • Funding: NIH National Institute of Neurological Disorders and Stroke; others.

Limitations

  • Heterogeneity of HDP diagnoses.
  • Small number of strokes.
  • Stroke definition included transient ischemic attack.