Published online before print June 26, 2008, doi: 10.1161/STROKEAHA.107.514190
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(Stroke. 2008;39:e138.)
© 2008 American Heart Association, Inc.
Letters to the Editor |
Pregnancy Is an Essential Spontaneous Screening Stress Test for the Risk of Early Stroke in Women
Department of Obstetrics and Gynaecology, Assistance Publique Hopitaux de Paris, Hopital Jean Verdier, University of Paris 13, Paris, France
To the Editor:
Boden-Albala et al1 evaluated the effect of the metabolic syndrome on stroke risk in a 3298 stroke-free community residents prospectively followed-up for a mean of 6.4 years. They observed that this risk was greater among women (hazard ratios=2.0; 95% CI, 1.3 to 3.1) than men (hazard ratios=1.1; 95% CI, 0.6 to 1.9). However, like others,2,3 they did not analyze the course of the pregnancies during the meantime in these women.
However, pregnancy may be considered an essential metabolic and vascular spontaneous screeening stress test for early stroke and coronary heart disease in women,4 and the metabolic syndrome is a possible underlying mechanism common to cardiovascular disease and pre-eclampsia.5
Ray et al6 assessed the risk of premature cerebrovascular, coronary, or peripheral artery disease over a 14-year period. They showed that this risk was higher after pre-eclampsia with placental dysfunction, and that the future risk of cardiovascular disease in these women was higher when they presented with the features of the metabolic syndrome. Their study supported that the future risk of cardiovascular disease was highest in women who had pre-eclampsia in combination with poor fetal growth. Smith et al7 also demonstrated from a population-based study that the subsequent maternal risk of ischemic heart disease during a 15- to 19-year follow-up was associated with pre-eclampsia.
Thus, further studies that aim to assess the risk factors of stroke in women should collect detailed data on the pregnancy course and outcomes. Indeed, after a placentally complicated pregnancy, women are at increased risk of later cerebrovascular and cardiovascular complications. The onset of the metabolic syndrome during pregnancies subsequently complicated by pre-eclampsia could define the highest-risk group. In these women, the postpartum is a favorable period for a cardiovascular and metabolic check, counseling, and may afford women the opportunity to take action through diet and lifestyle.
References
1. Boden-Albala B, Sacco RL, Lee HS. Metabolic Syndrome and Ischemic Stroke Risk. Northern Manhattan Study. Stroke. 2008; 39: 30–35.
2. Daviglus ML, Stamler J, Pirzada A Yan LL, Garside DB, Liu K, Wang R, Dyer AR, Lloyd-Jones DM, Greenland P. Favorable cardiovascular risk profile in young women and long-term risk of cardiovascular and all-cause mortality. JAMA. 2004; 292: 1588–1592.
3. Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000; 343: 16–22.
4. Newstead J, von Dadelszen P, Magee LA. Preeclampsia and future cardiovascular risk. Expert Rev Cardiovasc Ther. 2007; 5: 283–294.[CrossRef][Medline] [Order article via Infotrieve]
5. Harskamp RE, Zeeman GG. Preeclampsia: at risk for remote cardiovascular disease. Am J Med Sci. 2007; 334: 291–295.[CrossRef][Medline] [Order article via Infotrieve]
6. Ray JG, Vermeulen MJ, Schull MJ, Redelmeier DA. Cardiovascular health after maternal placental syndromes (CHAMPS): population-based retrospective cohort study. Lancet. 2005; 366: 1797–1803.[CrossRef][Medline] [Order article via Infotrieve]
7. Smith GC, Pell JP, Walsh D. Pregnancy complications and maternal risk of ischaemic heart disease: a retrospective cohort study of 129,290 births. Lancet. 2001; 357: 2002–2006.[CrossRef][Medline] [Order article via Infotrieve]
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