Abstract Details

Title Aspirin Reduces Long Term Stroke Risk in Women with Prior Hypertensive Disorders of Pregnancy

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S35 - Stroke Prevention Strategies (1:44 PM-1:55 PM)

Poster/Presentation
Number 005

Background HDP are associated with increased long-term cardiovascular risk, including stroke. Aspirin treatment during pregnancy reduces preeclampsia incidence among high risk women. Whether continued aspirin use after pregnancy is beneficial in women with a history of preeclampsia is unknown. Guidelines to inform primary prevention with aspirin or lipid-lowering therapy, do not include history of HDP in risk calculations.

Objective To determine if hypertensive disorders of pregnancy (HDP) increased long-term stroke risk in women in the California Teachers Study (CTS), a prospective cohort study, and if aspirin or statin use modified this risk.

Design/Methods CTS participants aged ≤60 years at time of enrollment in 1995 were followed prospectively for validated stroke outcomes obtained via linkage with California hospital records through 12/31/2015. We calculated unadjusted and adjusted hazard ratios (HR) and 95% confidence intervals (95%CI) for the primary outcomes of (1) all stroke and (2) stroke before age 60, among those with and without history of HDP. We tested for interactions (p<0.2) and performed stratified analyses to assess risk of the primary outcomes in women with and without self-reported use of aspirin or statins.

Results Of 83,749 women included in the analysis, 4070 (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: non-aspirin users 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.

Conclusions Controlling for comorbidities, 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 prior HDP.

Authors/Disclosures
Eliza C. Miller, MD (Columbia University Dept of Neurology) PRESENTER	Dr. Miller has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for medical malpractice cases. The institution of Dr. Miller has received research support from National Institutes of Health. Dr. Miller has a non-compensated relationship as a member of ASA Advisory Council with American Heart Association/American Stroke Association that is relevant to AAN interests or activities.
Amelia K. Boehme, PhD (Columbia University)	Dr. Boehme has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Kamakshi Lakshminarayan, MD, PhD (University of Minnesota)	Dr. Lakshminarayan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for ABBOTT Labs. The institution of Dr. Lakshminarayan has received research support from NIH.
	No disclosure on file
Daniel Woo, MD, FAAN (University at Buffalo)	The institution of Dr. Woo has received research support from NIH.
	No disclosure on file
	No disclosure on file
Mitchell S. Elkind, MD, MS, FAAN	Dr. Elkind has received personal compensation for serving as an employee of American Heart Association. Dr. Elkind has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Atria Academy.
Joshua Z. Willey, MD (Columbia University)	Dr. Willey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbott. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Edwards Scientific. Dr. Willey has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for RECARDIO. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbott. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BrainQ. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of the American College of Cardiology. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Uptodate. The institution of Dr. Willey has received research support from NIH. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving as a Review chapter author, MKSAP 16-20 with American College of Physicians.

��ɫ��

��ɫ��