Article

Secondary prevention in ischaemic stroke and transient
ischaemic attack (TIA) is dominated by pharmacological interventions with
evidence for non-pharmacological interventions being less robust.
This systematic
review and meta-analysis examines the impact of lifestyle interventions on
secondary prevention in stroke or TIA. METHODS: A systematic literature search
was performed. Randomised controlled trials (RCTs) examining the effectiveness of
intervention packages incorporating any key component of health
education/promotion/counselling on lifestyle and/or aerobic exercise compared to
usual care +/- a sham intervention in participants with ischaemic stroke or TIA
were included. Outcomes of interest were mortality, cardiovascular disease (CVD)
event rates, cardiovascular risk factors including blood pressure, lipid profiles
and physical activity participation. Methodological quality was assessed.
Statistical analyses determining treatment effect were conducted using Cochrane
Review Manager Software. RESULTS: Seventeen RCTs were included. Data pooled from
eight studies with a total of 2478 patients, demonstrated no effect in favour of
lifestyle interventions compared to routine or sham interventions on mortality
(risk ratio (RR) = 1.13 (95% confidence interval (CI), 0.85-1.52), I2 = 0%). Data
relating to CVD events were pooled from four studies (1013 patients),
demonstrated non-significant findings (RR = 1.16 (95% CI, 0.80--1.71), I2 = 0%).
Similar results were reported for total cholesterol. Physical activity
participation demonstrated significant improvement [SMD 0.24 (95% CI, 0.08-0.41),
l 2 = 47%]. Blood pressure reductions were noted but were non-significant when
corrected for multimodal packages including enhanced pharmacotherapy compliance.
CONCLUSIONS: There is currently insufficient high quality research to support
lifestyle interventions post-stroke or TIA on mortality, CVD event rates and
cardio-metabolic risk factor profiles. Promising blood pressure reductions were
noted in multimodal interventions which addressed lifestyle.
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Langue : ANGLAIS