After adjusting for time-varying covariates, preeclampsia may be an independent risk factor for later-life stroke in women who have had 1 or more pregnancies, according to results from the secondary analysis of the Framingham Heart Study published in JAMA Network Open.
A team of investigators conducted a population-based cohort study to determine whether a history of preeclampsia affected the relative risk for incident stroke after factoring in time-varying covariates. They did so by using marginal structural models.
Study investigators included women with 1 or more pregnancies who were stroke free at the time of enrollment, had a minimum of 3 study visits, and at least 1 pregnancy prior to menopause, hysterectomy, or age 45 years in the analysis. The main study outcome was the incidence of stroke later in life.
Of the 1435 women enrolled in the Framingham Heart Study (mean age, 44.4 years; accumulated observation, 51,600 person-years), 169 women (11.8%) had a history of preeclampsia. Stroke occurred in 231 women (16.1%) and an average of 32.4 years following baseline. Study researchers observed stroke events in 30 of 169 women (17.8%) and 201 of 1266 women (15.9%) with and without a history of preeclampsia, respectively.
At baseline, women with a history of preeclampsia were more likely to be younger, receiving treatment for hyperlipidemia, current smokers, have lower serum total cholesterol levels, and higher diastolic blood pressure compared with women without a history of preeclampsia.
At final visit, women with a history of preeclampsia were more likely to have higher blood glucose levels and lower phospholipid levels. They were more likely to receive treatment for hyperlipidemia and hypertension compared with women who did not have a history of preeclampsia.
The marginal structural model provided a link between preeclampsia and stroke only when adjustments were made for all vascular risk factors throughout the course of life. Following this adjustment, women with a history of preeclampsia had a relative risk of 3.79 for later-life stroke compared with women without such history.
“Future research is warranted to fully explore the mediation of this association by midlife vascular risk factors,” the study investigators concluded.
Disclosure: Multiple authors declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.
de Havenon A, Delic A, Stulberg E, et al. Association of preeclampsia with incident stroke in later life among women in the Framingham Heart Study. JAMA Netw Open. 2021;4(4):e215077. doi:10.1001/jamanetworkopen.2021.5077