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Clinician Article

Lifestyle Interventions to Prevent Cardiovascular Events After Stroke and Transient Ischemic Attack: Systematic Review and Meta-Analysis.



  • Deijle IA
  • Van Schaik SM
  • Van Wegen EE
  • Weinstein HC
  • Kwakkel G
  • Van den Berg-Vos RM
Stroke. 2017 Jan;48(1):174-179. doi: 10.1161/STROKEAHA.116.013794. Epub 2016 Dec 6. (Review)
PMID: 27924055
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Disciplines
  • Neurology
    Relevance - 6/7
    Newsworthiness - 6/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 6/7
    Newsworthiness - 5/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 6/7
    Newsworthiness - 5/7
  • Internal Medicine
    Relevance - 6/7
    Newsworthiness - 5/7
  • Cardiology
    Relevance - 4/7
    Newsworthiness - 4/7

Abstract

BACKGROUND AND PURPOSE: Patients with a transient ischemic attack or ischemic stroke have an increased risk of subsequent cardiovascular events. The purpose of this systematic review and meta-analysis was to determine whether lifestyle interventions focusing on behaviorally modifiable risk factors with or without an exercise program are effective in terms of (1) preventing recurrent cardiovascular events, (2) reducing mortality, and (3) improving modifiable risk factors associated with cardiovascular disease in patients after a transient ischemic attack or ischemic stroke.

METHODS: For this systematic review and meta-analysis, we systematically searched PubMed, Embase, PsycInfo, and the Cochrane Library from the start of the database to May 7, 2015. Subgroup analyses were conducted to explore the influence of therapy-related factors.

RESULTS: Twenty-two randomized controlled trials were identified with a total of 2574 patients. Pooling showed a significant reduction in systolic blood pressure by the lifestyle interventions applied, compared with usual care (mean difference, -3.6 mm Hg; 95% confidence interval, -5.6 to -1.6, I2=33%). No significant effect was found on cardiovascular events, mortality, diastolic blood pressure, or cholesterol. In the subgroup analyses, the trials with cardiovascular fitness interventions, trials with an intervention that lasted longer than 4 months, and interventions that used >3 behavior change techniques were more effective in reducing systolic blood pressure.

CONCLUSIONS: We found that lifestyle interventions are effective in lowering systolic blood pressure. About other end points, this systematic review found no effect of lifestyle interventions on cardiovascular event rate mortality, diastolic blood pressure, or total cholesterol.


Clinical Comments

General Internal Medicine-Primary Care(US)

Despite the lukewarm results showing limited benefits of lifestyle modifications post-stroke or post transient ischemic attack, practitioners likely will recommend appropriate diet and physical activity not only for blood pressure effects but also other potential benefits, e.g. reduction in falls and improvements in activities of daily living function.

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