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After an ischemic stroke or transient ischemic attack, lifestyle interventions reduce systolic blood pressure but do not improve other outcomes

Deijle 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.

Review question

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?

Background

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.

How the review was done

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:

  • people had a previous ischemic stroke or TIA;
  • lifestyle interventions focused on changing behaviour, improving fitness levels through exercise, or both;
  • lifestyle interventions were mostly compared with usual care;
  • most interventions were done over 2 to 12 months; and
  • most people were followed for 2 to 6 months.

What the researchers found

Compared with usual care, lifestyle interventions:

  • reduced systolic blood pressure by an average 3.6 mm Hg;
  • improved physical activity levels in some trials but not in others; and
  • were no better for reducing CV events, deaths, diastolic blood pressure, or total cholesterol levels.

Conclusion

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.

Lifestyle interventions vs usual care in people who have had a previous ischemic stroke or transient ischemic attack*

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.

*BP = blood pressure; CV = cardiovascular.

†Events such as recurrent stroke, heart attack, or death related to CV events. ‡Although the rates for the 2 groups look a little different, the differences were not statistically significant. This means that the differences could simply be due to chance rather than due to the different interventions.



Related Topics


Glossary

Diastolic
The lower number in a blood pressure reading. It is the pressure when the heart rests between beats.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Risk factors
Aspects making a condition more likely.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.
Systolic
The higher number in a blood pressure reading. It is the pressure in the arteries when the heart beats.
Vascular
The body's network of blood vessels. It includes the arteries, veins, and capillaries that carry blood to and from the heart.

Related Evidence Summaries

Related Web Resources

  • After a stroke: Does fitness training improve health and mobility?

    Informed Health Online
    Fitness training after a stroke can improve physical fitness and mobility, but can require a lot of effort and motivation. Examples of fitness training include Nordic walking, treadmills, or exercise bikes.
  • Stroke Prevention: Should I Have a Carotid Artery Procedure?

    OHRI
    This patient decision aid helps people who have had a mild (or moderate) stroke or one or more TIAs in the past 6 months and narrowing in your carotid artery decide on whether or not to have a carotid artery procedure by comparing the benefits, risks, and side effects of both options.
  • Statins: Should I Take Them to Prevent a Heart Attack or Stroke?

    OHRI
    This patient decision aid helps people considering taking medicines called statins to lower their risk of heart attack and stroke by comparing the benefits, risks, and side effects of both options. It also includes alternative treatment options to taking statins such as trying to lower risk with lifestyle changes.
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