Stroke prevention: How low can you go?

Stroke is the fourth-leading cause of death in the United States and a leading cause of long-term disability.(1,2) However, the rate of stroke has fallen dramatically in high-income countries over the past 40 years.(3) This drop is attributed to better preventive care that addresses stroke risk factors, including better control of hypertension, increased use of statins, and the successful societal campaign to reduce smoking. Although uncommon in young patients, stroke risk increases during pregnancy and the postpartum period, and stroke is a leading cause of long-term disability in young women, both physical disability and depression. Preeclampsia-eclampsia (PEE) underlies a large proportion of strokes associated with pregnancy.(4) PEE also correlates with a higher lifelong risk of cardiovascular disease, including stroke.(5,6) It remains unclear whether PEE simply identifies those at high risk or causes long-lasting multiorgan vascular effects that confer later vulnerability.(7) The identification of PEE as a risk factor for future stroke raises important questions of risk stratification and preventive therapy.