Prevalence of an abnormal ankle-brachial index in patients with antiphospholipid syndrome with pregnancy loss but without thrombosis: a controlled study
Authors: C Christodoulou, M Zain, M L Bertolaccini, S Sangle, M A Khamashta, G R V Hughes, D P D'Cruz
Journal: Annals of the Rheumatic Diseases (2006)

<h3>Objective:</h3> 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. <h3>Background:</h3> 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. <h3>Design/Methods:</h3> 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&lt;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. <h3>Results:</h3> 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. <h3>Conclusions:</h3> 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. <b>Disclosure:</b> Dr. Miller has nothing to disclose. Dr. Boehme has nothing to disclose. Dr. Chung has nothing to disclose. Dr. Wang has nothing to disclose. Dr. Lacey has nothing to disclose. Dr. Lakshminarayan has nothing to disclose. Dr. Zhong has nothing to disclose. Dr. Woo has nothing to disclose. Dr. Bello has nothing to disclose. Dr. Wapner has nothing to disclose. Dr. Elkind has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Abbott, Vascular Dynamics, Merck/Organon Auxilium, and Sorin. Dr. Elkind has received research support from BMS-Pfizer Alliance, and Roche. Dr. Willey has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with MKSAP 18, American College of Physicians, Edwards Scientific, Medtronic, Grand Rounds Expert Care. Dr. Willey has received personal compensation in an editorial capacity for Uptodate.com.