Similar results were reported for total cholesterol .
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
Background and purpose 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 .
Results of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Trial by Stroke Subtypes
Background and Purpose — The SPARCL trial showed that atorvastatin 80 mg/d reduces the risk of stroke and other cardiovascular events in patients with recent stroke or transient ischemic attack ( TIA ) . We tested the hypothesis that the benefit of treatment varies according to index event stroke subtype . Methods — Subjects with stroke or TIA without known coronary heart disease were r and omized to atorvastatin 80 mg/d or placebo .  The SPARCL primary end point was fatal or nonfatal stroke . Secondary end points included major cardiovascular events ( MCVE ; stroke plus major coronary events ) . Cox regression models testing for an interaction with treatment assignment were used to explore potential differences in efficacy based on stroke subtype . Results — For subjects r and omized to atorvastatin versus placebo  , a primary end point occurred in 13.1 % versus 18.6 % of those classified as having large vessel disease ( LVD , 15.8 % of 4,731 participants ) , in 13.1 % versus 15.5 % of those with small vessel disease ( SVD , 29.8 % ) , in 11.2 % versus 12.7 % of those with ischemic stroke of unknown cause ( 21.5 % ) , in 7.6 % versus 8.8 % of those with TIA ( 30.9 % ) , and in 22.2 % versus 8.3 % of those with hemorrhagic stroke ( HS , 2 % ) at baseline . There was no difference in the efficacy of treatment for either the primary end point ( LVD hazard ratio [ HR ] 0.70 , 95 % confidence interval [ CI ] 0.49 to 1.02 , TIA HR 0.81 , CI 0.57 to 1.17 , SVD HR 0.85 , CI 0.64 to 1.12 , unknown cause HR 0.87 , CI 0.61 to 1.24 , HS HR 3.24 , CI 1.01 to 10.4 ; P for heterogeneity=0.421 ) , or MCVEs ( P for heterogeneity=0.360 ) based on subtype of the index event . As compared to subjects with LVD strokes , those with SVD had similar MCVE rates ( 19.2 % versus 18.5 % over the course of the trial ) , and similar overall reductions in stroke and MCVEs . Conclusions — Atorvastatin 80 mg/d is similarly efficacious in preventing strokes and other cardiovascular events , irrespective of baseline ischemic stroke subtype
Similar results were reported for total cholesterol .
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
Background and purpose 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 .