University of Miami Miller School of Medicine, Miami, Florida.
Jackson Memorial Hospital, Miami, Florida.
J Stroke Cerebrovasc Dis. 2020 Jun;29(6):104720. doi: 10.1016/j.jstrokecerebrovasdis.2020.104720. Epub 2020 Mar 24.
To evaluate the development and management of cerebrovascular risk factors following a pregnancy with preeclampsia.
This is a retrospective chart review including women diagnosed with preeclampsia between 2012 and 2013 with later encounters within 2014-2016. For each subject that met inclusion criteria, the development of cerebrovascular risk factors was determined using ICD codes within the 2014-2016 electronic medical record (EMR). For subjects who developed risk factors, current treatment was determined from the EMR. Demographic data was also documented. Differences in the development and treatment of risk factors were compared among racial groups and age. Descriptive statistics were calculated using SAS statistical software.
Compared to prepregnancy health status, the incidence of hypertension increased by 1.7 times (P < .05), hyperlipidemia increased by 4.5 (P < .05), migraines increased by 2.2 (P < .05), and diabetes mellitus increased by 2 (P < .05) after a pregnancy with preeclampsia. Black non-Hispanics had highest rates of hypertension, obesity, and migraines (20.5%, 9.1%, and 6.8%, respectively.) Of hypertensives, 73.6% (42/57) were prescribed medication. Of diabetics, 88.9% (16/18) were prescribed medication. No patients with hyperlipidemia were prescribed a statin. Black non-Hispanics had higher rates of risk factor management (74.3% of hypertensives and 100% of diabetics treated) than white Hispanics (55% and 77.8%, respectively).
This study shows a significant increased risk of the development of cerebrovascular risk factors such as hypertension, hyperlipidemia, migraines, and diabetes following a diagnosis of preeclampsia. Opportunities exist for the early treatment of these risk factors, which could reduce the long-term rate of stroke in these women.
评估子痫前期妊娠后脑血管危险因素的发生和管理情况。
这是一项回顾性图表研究，纳入了 2012 年至 2013 年间诊断为子痫前期的女性患者，随后在 2014 年至 2016 年期间进行了随访。对于符合纳入标准的每位患者，通过 2014 年至 2016 年电子病历（EMR）中的 ICD 编码确定脑血管危险因素的发生情况。对于发生危险因素的患者，从 EMR 中确定当前的治疗方法。还记录了人口统计学数据。比较了不同种族和年龄组患者危险因素的发生和治疗差异。使用 SAS 统计软件计算描述性统计数据。
与妊娠前健康状况相比，子痫前期妊娠后高血压的发病率增加了 1.7 倍（P<.05），高脂血症增加了 4.5 倍（P<.05），偏头痛增加了 2.2 倍（P<.05），糖尿病增加了 2 倍（P<.05）。黑人非西班牙裔患者高血压、肥胖和偏头痛的发生率最高（分别为 20.5%、9.1%和 6.8%）。高血压患者中，73.6%（42/57）接受了药物治疗。糖尿病患者中，88.9%（16/18）接受了药物治疗。没有高脂血症患者接受他汀类药物治疗。黑人非西班牙裔患者的危险因素管理率高于白西班牙裔患者（高血压患者分别为 74.3%和 55%，糖尿病患者为 100%和 77.8%）。
本研究表明，子痫前期诊断后，高血压、高脂血症、偏头痛和糖尿病等脑血管危险因素的发生风险显著增加。有机会对这些危险因素进行早期治疗，从而降低这些女性长期中风的风险。
