Women with a history of hypertensive disorders of pregnancy (HDP) have an increased long-term risk for stroke, yet this risk appears to be mitigated by aspirin use, according to findings published in Neurology.

Female teachers who participated in the prospective California Teachers Study and who were aged ≤60 years in 1995 were included in the analysis. Researchers followed women prospectively through December 31, 2015, for validated stroke outcomes, using data from California hospital records. The primary outcomes included all stroke and stroke before 60 years of age in women with and without an HDP history. In addition, analyses were stratified to evaluate the risk for the primary outcomes with women who did and did not report taking aspirin or statins up to follow-up.

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A total of 4070 women included in the analysis had HDP, representing 4.9% of the total cohort (N=83,749). Prior HDF was associated with an increased risk for all stroke (adjusted hazard ratio [HR], 1.3; 95% CI, 1.2-1.4), yet there was no increased risk for stroke before age 60 years in women with prior HDP (adjusted HR, 1.2; 95% CI, 0.9-1.7). An interaction was found between HDP history and aspirin use on stroke risk before the age of 60 years (P =.18). Specifically, women who did not report using aspirin had a higher risk for stroke (adjusted HR, 1.5; 95% CI, 1.0-2.1) compared with self-reported aspirin users who did not have an increased stroke risk (adjusted HR, 0.8; 95% CI, 0.4-1.7). No effect on stroke risk was observed in patients who used statins.

Limitations of the study include the small number of stroke outcomes in the overall cohort, the heterogeneity of HDP diagnoses, and the inclusion of only female teachers.

“History of HDP should be considered an important risk factor for future stroke, and some women with this history may warrant primary preventive treatment with aspirin even in the absence of additional vascular risk factors,” the researchers wrote.

Reference

Miller EC, Boehme AK, Chung NT, et al. Aspirin reduces long-term stroke risk in women with prior hypertensive disorders of pregnancy. Neurology. 2019;92(4):e305-e316.