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.
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