Abstract Details

Title Aspirin and Statins Reduce the Risk of Stroke in Women with Endometriosis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S3 - Cerebrovascular Disease and Interventional Neurology: Diagnosis, Prognosis, and Population Health (1:12 PM-1:24 PM)

Poster/Presentation
Number 002

Background Endometriosis is an inflammatory chronic gynecologic condition that affects approximately 10% of reproductive aged women. Previous research suggests that endometriosis increases stroke risk, but the role of medications known to prevent stroke in modifying this risk is uncertain.

Objective

To determine (1) the risk of stroke in women with endometriosis and (2) the effect of aspirin and statins on that risk.

Design/Methods We retrospectively analyzed data from the California Teachers Study, a large prospective cohort of female teachers followed continuously since 1995, excluding those with prior stroke or heart attack. This analyses’ exposure was self-reported history of endometriosis, and the outcome was hospitalization for any stroke (ischemic stroke, intracerebral and subarachnoid hemorrhage). Study covariates were self-reported use of aspirin and statin, race-ethnicity, hysterectomy, and vascular risk factors: hypertension, diabetes mellitus, obesity, migraine, current or prior tobacco use, malignancy, and oral contraceptive use. We used Cox proportional hazards models to calculate hazard ratios (HR) and 95% confidence intervals (CI) for stroke by age among women with and without history of endometriosis after adjustment for demographics and vascular risk factors. We examined association of aspirin and statin use with stroke among women with endometriosis.

Results Of 121,993 women, 13,938 (11.4%) reported a history of endometriosis. Women with endometriosis had slightly higher rates of vascular risk factors than women without endometriosis. Adjusted risk of stroke in the endometriosis group was higher than in the non-endometriosis group (HR 1.20, CI 1.09-1.28). Stroke occurred at a younger age among women with endometriosis (77.9 vs 80.2, p<0.01). Within the endometriosis group, stroke risk in users of aspirin (HR 0.80, CI 0.69-0.92) or statins (HR 0.74, CI 0.62-0.88) was lower than that of non-users.

Conclusions In a large cohort study, history of endometriosis was associated with increased stroke risk and, among women with endometriosis, aspirin and statin use decreased this risk.

Authors/Disclosures
Alison Seitz, MD (New York Presbyterian Hospital) PRESENTER	Dr. Seitz has stock in Baxter International Inc. (<0.0003% ownership), Bristol-Myers Squibb Company (<0.0001%), Colgate-Palmolive Company (<0.0002%), CVS Health Corporation (<0.0002%), Johnson & Johnson (<0.00004%), Eli Lilly and Company (<0.00005%), Proctor & Gamble Company (<0.00005%), UnitedHealth Group Incorporated (<0.00002%), Walgreen Boots Alliance, Inc. (<0.0002%), White Mountains Insurance (<0.002%).
Leslie E. Bull, MA	Ms. Bull has stock in United Bank. Ms. Bull has received research support from Weill Cornell Medical College.
Neal S. Parikh, MD (Alnylam Pharmaceuticals)	Dr. Parikh has received personal compensation for serving as an employee of Alnylam Pharmaceuticals. Dr. Parikh has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for cases of neurological illness. Dr. Parikh has stock in Alnylam Pharmaceuticals. The institution of Dr. Parikh has received research support from Leon Levy Foundation. The institution of Dr. Parikh has received research support from Florence Gould Foundation. The institution of Dr. Parikh has received research support from NY State Empire Clinical Research Investigator Program. The institution of Dr. Parikh has received research support from NIA. The institution of Dr. Parikh has received research support from Medtronic.
Babak Navi, MD (Weill Cornell Medical College)	Dr. Navi has nothing to disclose.
Alexander Merkler, MD	Dr. Merkler has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for The Neurohospitalist. Dr. Merkler has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for n/a.
Hooman Kamel, MD (Weill Cornell Medical College)	Dr. Kamel has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Kamel has received personal compensation in the range of $50,000-$99,999 for serving as a Endpoint adjudication committee with Boehringer-Ingelheim.
Ava L. Liberman, MD (Weill Cornell Medicine)	The institution of Dr. Liberman has received research support from NIH.