Pregnancy Is an Essential Spontaneous Screening Stress Test for the Risk of Early Stroke in Women
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.