Preeclampsia Increases Risk of Early Stroke Incidence: The California Teachers Study Eliza C. Miller MD, 1 Amelia K. Boehme PhD MSPH, 1 Nadia T. Chung MPH, 2 James V. Lacey, Jr. PhD, 2 Jeanine Genkinger PhD, 3 Yeseon Park Moon MS, 1 Leslie Bernstein PhD, 2 Sophia S. Wang PhD, 2 Mary D’Alton MD, 4 Mitchell S.V. Elkind MD MS, 1,3 Ronald Wapner MD, 4 Joshua Z. Willey MD MS 1 1. Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY. 2. City of Hope National Medical Center, Duarte, CA. 3. Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY. 4. Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY.
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Preeclampsia Increases Risk of Early Stroke Incidence:
The California Teachers Study
Eliza C. Miller MD,1 Amelia K. Boehme PhD MSPH, 1 Nadia T. Chung MPH,2 James V. Lacey, Jr. PhD, 2 Jeanine Genkinger PhD,3 Yeseon Park
Moon MS, 1 Leslie Bernstein PhD, 2 Sophia S. Wang PhD, 2 Mary D’Alton MD,4 Mitchell S.V. Elkind MD MS, 1,3 Ronald Wapner MD, 4 Joshua Z.
Willey MD MS1
1. Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY. 2. City of Hope National Medical Center, Duarte, CA.3. Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY. 4. Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY.
Disclosures: None
Funding: NIH NINDS StrokeNet Training Core
Some recent patients
• Common and under-recognized CV risk factor
• Severe effects on cerebral vasculature
• Quadruples risk of hypertension & heart failure, doubles long term stroke risk
• Associated with metabolic syndrome later in life
• Increased white matter hyperintensities and carotid intima-media thickening years later
Preeclampsia: a complex disorder
Mongraw-Chaffin et al., Hypertension, 2010Jong Shiuan Yeh et al. J Am Heart Assoc 2014;3:e001008Hammer & Cipolla, Current Hypertension Reports, 2015
Aspirin and preeclampsia
• ASPRE trial, NEJM 2017: aspirin 150 mg started at 11-14 wks gestation reduced incidence of preterm preeclampsia in high risk women (1.6% vs 4.3%; NNT 38)
• USPSTF/ACOG guidelines recommend low dose aspirin starting in first trimester for high risk women
• No recommendations for aspirin use after preeclampsia
• Obstetric history not incorporated into CV risk calculators
Rolnick et al, ASPRE trial NEJM 2017
Hypotheses:
1. Women with history of preeclampsia have higher risk of stroke before age 60