Comparative Effects of Non-Pharmacological Interventions for Stroke Prevention in Adults: A Network Meta-Analysis.

INTRODUCTION

Existing guidelines lack comprehensive recommendations for stroke prevention. This network meta-analysis aimed to evaluate the comparative efficacy of non-pharmacological interventions in preventing total stroke and fatal stroke in high-risk adults.

METHODS

We pooled only randomized controlled trials (RCTs). Relative risks (RRs), 95% confidence intervals (CIs), and P scores were computed to compare and rank the efficacy of interventions in preventing stroke.

RESULTS

50 RCTs with 673,624 participants were pooled in this study. Compared with the control group, Exercise + Education may decrease stroke risk (RR = 0.23; 95% CI: 0.07-0.73; low strength of evidence [SOE]), followed by Exercise (RR = 0.40; 95% CI: 0.28-0.57; moderate SOE), Mediterranean diet (RR = 0.70; 95% CI: 0.50-0.97; low SOE), and Vitamin B6 combined with B12 and folic acid (Vitamin B6 + B12 + folic acid) (RR = 0.86; 95% CI: 0.77-0.95; moderate SOE). Only Salt substitute showed significantly reduced fatal stroke risk (RR = 0.78; 95% CI: 0.68-0.90; high SOE). Exercise + Education (low SOE) and Exercise alone (moderate SOE) showed short-term benefits on preventing stroke, while Salt substitute had long-term effects on reducing fatal stroke risk (high SOE). Carotid endarterectomy (moderate SOE) and Vitamin C (high SOE) were significantly effective in preventing ischemic stroke, and Salt substitute (high SOE) showed significantly reduced hemorrhagic stroke and fatal hemorrhagic stroke risks. Vitamin B6 + B12 + folic acid may lower hemorrhagic stroke and transient ischemic attack risks (moderate SOE).

CONCLUSION

Future studies should prioritize high-quality RCTs with large sample sizes, different follow-up durations and specific stroke types to confirm the efficacy of these non-pharmacological interventions.