Aspirin can reduce the risk of stroke in women with a history of preeclampsia

Middle-aged women with a history of pre-eclampsia have a higher risk of stroke, and aspirin might possibly reduce this risk, according to a new study by researchers Columbia College Vagelos College of Physicians & Surgeons. The study was published today in the journal Neurology, accompanied by an editorial and a podcast.

Why is it important

Although preeclampsia rates are declining or stable in other developed countries, they are increasing rapidly in the United States, where about one in 20 pregnancies is complicated by preeclampsia and other pregnancy-related hypertension disorders. .

Preeclampsia increases the long-term risk of cardiovascular disease, including stroke, the leading cause of disability and death in women. Although younger patients with stroke are generally less impaired in the short term than older patients, years of disability and loss of income can have serious long-term consequences.

Context

Low-dose aspirin treatment during pregnancy reduces the incidence of pre-eclampsia in high-risk women, but most women stop taking aspirin after childbirth . It is not known whether the use of aspirin after childbirth offers long-term benefits.

What the study found

Researchers used data from 84,000 women enrolled in the California Teachers Study; of these, about 4,000 had a history of preeclampsia. Women are considered regular users of aspirin if they report taking aspirin three or more times a week after childbirth for at least a year.

The researchers found that the overall risk of stroke was 30% higher in women with a history of preeclampsia than in those with no history.

Regular use of aspirin seemed to erase the increased risk of stroke badociated with preeclampsia, but only in women younger than 60 years old. Aspirin users in this age group with a history of preeclampsia had the same risk of stroke as women with no previous history. In comparison, formerly preeclamptic women in this age group who did not take aspirin had a 50% higher stroke risk.

The use of aspirin did not have a significant effect on reducing the risk of excessive stroke in women over 60 with a history of preeclampsia.

What this means

The study is a first step in exploring the idea that aspirin can prevent strokes in women with a history of preeclampsia.

"It would be premature, at this stage, to recommend aspirin to all women with a history of preeclampsia, because aspirin can have serious side effects, such as bleeding that result in hospitalization," he said. said senior author Eliza C. Miller, MD neurologist at Irving Medical Center at Columbia University.

But Miller says that aspirin can be justified for some of these women. Many organizations are currently recommending low-dose aspirin to prevent heart attacks and strokes in some people at high risk for cardiovascular disease.

"A history of preeclampsia is not currently considered in the calculation of 10-year cardiovascular risk, but it will likely need to be incorporated into risk badessment recommendations," Miller said. "Some women with these antecedents may need primary preventive treatment with aspirin, even in the absence of additional vascular risk factors."

Next steps

The current study was observational and only shows that aspirin is badociated with a reduced risk of stroke in women with a history of preeclampsia.

Randomized controlled trials are needed to establish the efficacy of aspirin in the primary prevention of stroke in some women with a history of preeclampsia.

Limits of study

The study group was largely white and may not be representative of all affected women. "Some women's groups, particularly African-Americans, have a higher risk of preeclampsia and stroke, and it's possible that the effect of aspirin is even more potent at home. these groups, "said Miller.

Provided by
Irving Medical Center at Columbia University