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Got It, Hide thisDeijle IA, Van Schaik SM, Van Wegen EE, et al. Lifestyle Interventions to Prevent Cardiovascular Events After Stroke and Transient Ischemic Attack: Systematic Review and Meta-Analysis. Stroke. 2017;48:174-9.
In people who have had a previous ischemic stroke or transient ischemic attack (TIA), do lifestyle interventions prevent another cardiovascular (CV) event or death, or reduce CV risk factors?
A stroke happens when blood flow to the brain is interrupted or blocked and brain cells are damaged or die. Most strokes are caused by blood clots in arteries of the brain (ischemic strokes). TIAs, also called mini strokes, cause a temporary blockage of the blood flow to the brain, but they don’t cause permanent damage.
People who have had a previous stroke or TIA are at increased risk for another CV event, such as recurrent stroke or heart attack. Risk factors for future CV events include being inactive or overweight, having high blood pressure or abnormal fat (cholesterol) levels in the blood, drinking a lot of alcohol, smoking, and not taking medications properly. Programs that promote lifestyle changes to reduce these risk factors may help prevent future CV events.
The researchers did a systematic review, searching for studies that were published to May, 2015. They found 22 randomized controlled trials with 2,574 people who were 18 years of age or older (average age 60 to 75 years old). Most trials included similar numbers of men and women.
The key features of the trials were:
Compared with usual care, lifestyle interventions:
In people who have had a previous ischemic stroke or transient ischemic attack, lifestyle interventions that encourage such behaviours as following a healthy diet, not smoking, and being more physically active, reduce systolic blood pressure but not cardiovascular events, deaths, diastolic blood pressure, or total cholesterol levels.
Main outcomes | Number of trials and people | Rate of events with lifestyle interventions | Rate of events with usual care | Absolute effect of lifestyle interventions |
CV events† | 4 trials (506 people) | 10% | 13% | No difference in effect‡ |
Death | 4 trials (1,422 people) | 9.0% | 7.8% | No difference in effect‡ |
Systolic BP | 10 trials (650 people) | — | — | Reduced systolic BP by 3.6 mm Hg on average (from as little as 1.6 to as much as 5.6 mm Hg). |
Diastolic BP | 10 trials (648 people) | — | — | No difference in effect. |
Total cholesterol (fat) levels | 3 trials (126 people) | — | — | No difference in effect. |
Physical activity | 12 trials (1,390 people) | — | — | Increased physical activity levels in 6 trials with 424 people; did not affect physical activity levels in 6 trials with 966 people. |