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Semin Neurol 2017; 37(03): 237-258
DOI: 10.1055/s-0037-1603685
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Modifiable Risk Factors for Stroke and Strategies for Stroke Prevention

Valerie A. Hill
1   Rancho Los Amigos National Rehabilitation Center, Rancho Research Institute, Downey, California
,
Amytis Towfighi
1   Rancho Los Amigos National Rehabilitation Center, Rancho Research Institute, Downey, California
2   Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California
3   Los Angeles County Department of Health Services, Los Angeles, California
› Author Affiliations
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Publication History

Publication Date:
31 July 2017 (online)

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Abstract

The pathophysiology of stroke is well characterized, and 9 out of 10 strokes are due to modifiable factors. However, preventive strategies thus far have been relatively ineffective in curbing the global stroke burden, which is projected to increase given the aging of the world's population and epidemiological transition in many low- to middle-income countries. In this review we will summarize our current understanding of behavioral, environmental, and metabolic stroke risk factors not covered elsewhere in this issue. Specifically, we will review the evidence for environmental and household air pollution, smoking, and alcohol use. We will subsequently provide a conceptual framework for stroke prevention strategies, categorizing them as those aimed at changing health care systems and/or provider behavior and those targeting behaviors of patients and/or their caregivers, families, and support networks. The field of stroke prevention is relatively nascent, and little is known about how to optimize health care systems so that providers prescribe evidence-based care for stroke prevention, patients have access to care to receive such services, adherence and control of risk factors are optimized, and patients are empowered to manage their own risk factors and make lifestyle changes, including eating healthy diets (high in fruits, vegetables, and whole grains and low in sodium and sugar-sweetened beverages), engaging in regular physical activity, not smoking, and limiting alcohol consumption. In the next several years, we will likely develop a better understanding of which strategies are effective for modifying vascular risk factors, and how to design and implement successful interventions. Key questions to be answered include optimal theoretical frameworks, delivery models, team composition, timing, dose, intensity, and frequency, taking into account cultural, sociodemographic, and regional differences in patient populations.

Keywords

stroke - prevention strategies - interventions - modifiable risk factors
 

  • References

  • 1 Feigin VL, Norrving B, Mensah GA. Global burden of stroke. Circ Res 2017; 120 (03) 439-448
    CrossrefPubMedGoogle Scholar
  • 2 Feigin VL, Roth GA, Naghavi M. , et al; Global Burden of Diseases, Injuries and Risk Factors Study 2013 and Stroke Experts Writing Group. Global burden of stroke and risk factors in 188 countries, during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Neurol 2016; 15 (09) 913-924
    CrossrefPubMedGoogle Scholar
  • 3 Beaglehole R, Bonita R, Horton R. , et al; Lancet NCD Action Group; NCD Alliance. Priority actions for the non-communicable disease crisis. Lancet 2011; 377 (9775): 1438-1447
    CrossrefPubMedGoogle Scholar
  • 4 Lloyd-Jones DM, Hong Y, Labarthe D. , et al; American Heart Association Strategic Planning Task Force and Statistics Committee. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond. Circulation 2010; 121 (04) 586-613
    CrossrefPubMedGoogle Scholar
  • 5 O'Donnell M, Xavier D, Diener C. , et al; INTERSTROKE investigators. Rationale and design of INTERSTROKE: a global case-control study of risk factors for stroke. Neuroepidemiology 2010; 35 (01) 36-44
    CrossrefPubMedGoogle Scholar
  • 6 Hackam DG, Spence JD. Combining multiple approaches for the secondary prevention of vascular events after stroke: a quantitative modeling study. Stroke 2007; 38 (06) 1881-1885
    CrossrefPubMedGoogle Scholar
  • 7 Coutts SB, Wein TH, Lindsay MP. , et al; Heart, and Stroke Foundation Canada Canadian Stroke Best Practices Advisory Committee. Canadian Stroke Best Practice Recommendations: secondary prevention of stroke guidelines, update 2014. Int J Stroke 2015; 10 (03) 282-291
    CrossrefPubMedGoogle Scholar
  • 8 Lichtman JH, Naert L, Allen NB. , et al. Use of antithrombotic medications among elderly ischemic stroke patients. Circ Cardiovasc Qual Outcomes 2011; 4 (01) 30-38
    CrossrefPubMedGoogle Scholar
  • 9 Razmara A, Ovbiagele B, Markovic D, Towfighi A. Patterns and predictors of blood pressure treatment, control, and outcomes among stroke survivors in the United States. J Stroke Cerebrovasc Dis 2016; 25 (04) 857-865
    CrossrefPubMedGoogle Scholar
  • 10 Lin MP, Ovbiagele B, Markovic D, Towfighi A. “Life's simple 7” and long-term mortality after stroke. J Am Heart Assoc 2015; 4 (11) 4
    PubMedGoogle Scholar
  • 11 Heuschmann PU, Kircher J, Nowe T. , et al. Control of main risk factors after ischaemic stroke across Europe: data from the stroke-specific module of the EUROASPIRE III survey. Eur J Prev Cardiol 2015; 22 (10) 1354-1362
    CrossrefPubMedGoogle Scholar
  • 12 Redfern J, McKevitt C, Wolfe CD. Development of complex interventions in stroke care: a systematic review. Stroke 2006; 37 (09) 2410-2419
    CrossrefPubMedGoogle Scholar
  • 13 Mateen FJ, Brook RD. Air pollution as an emerging global risk factor for stroke. JAMA 2011; 305 (12) 1240-1241
    CrossrefPubMedGoogle Scholar
  • 14 Shah AS, Lee KK, McAllister DA. , et al. Short term exposure to air pollution and stroke: systematic review and meta-analysis. BMJ 2015; 350: h1295
    PubMedGoogle Scholar
  • 15 Miller KA, Siscovick DS, Sheppard L. , et al. Long-term exposure to air pollution and incidence of cardiovascular events in women. N Engl J Med 2007; 356 (05) 447-458
    CrossrefPubMedGoogle Scholar
  • 16 Oudin A, Stroh E, Strömberg U, Jakobsson K, Björk J. Long-term exposure to air pollution and hospital admissions for ischemic stroke. A register-based case-control study using modelled NO(x) as exposure proxy. BMC Public Health 2009; 9: 301
    CrossrefPubMedGoogle Scholar
  • 17 Ostro B, Hu J, Goldberg D. , et al. Associations of mortality with long-term exposures to fine and ultrafine particles, species and sources: results from the California Teachers Study Cohort. Environ Health Perspect 2015; 123 (06) 549-556
    PubMedGoogle Scholar
  • 18 Muntner P, Menke A, DeSalvo KB, Rabito FA, Batuman V. Continued decline in blood lead levels among adults in the United States: the National Health and Nutrition Examination Surveys. Arch Intern Med 2005; 165 (18) 2155-2161
    CrossrefPubMedGoogle Scholar
  • 19 Navas-Acien A, Selvin E, Sharrett AR, Calderon-Aranda E, Silbergeld E, Guallar E. Lead, cadmium, smoking, and increased risk of peripheral arterial disease. Circulation 2004; 109 (25) 3196-3201
    CrossrefPubMedGoogle Scholar
  • 20 Navas-Acien A, Schwartz BS, Rothenberg SJ, Hu H, Silbergeld EK, Guallar E. Bone lead levels and blood pressure endpoints: a meta-analysis. Epidemiology 2008; 19 (03) 496-504
    CrossrefPubMedGoogle Scholar
  • 21 Weisskopf MG, Jain N, Nie H. , et al. A prospective study of bone lead concentration and death from all causes, cardiovascular diseases, and cancer in the Department of Veterans Affairs Normative Aging Study. Circulation 2009; 120 (12) 1056-1064
    CrossrefPubMedGoogle Scholar
  • 22 Menke A, Muntner P, Batuman V, Silbergeld EK, Guallar E. Blood lead below 0.48 micromol/L (10 microg/dL) and mortality among US adults. Circulation 2006; 114 (13) 1388-1394
    CrossrefPubMedGoogle Scholar
  • 23 Tellez-Plaza M, Jones MR, Dominguez-Lucas A, Guallar E, Navas-Acien A. Cadmium exposure and clinical cardiovascular disease: a systematic review. Curr Atheroscler Rep 2013; 15 (10) 356
    CrossrefPubMedGoogle Scholar
  • 24 Solenkova NV, Newman JD, Berger JS, Thurston G, Hochman JS, Lamas GA. Metal pollutants and cardiovascular disease: mechanisms and consequences of exposure. Am Heart J 2014; 168 (06) 812-822
    CrossrefPubMedGoogle Scholar
  • 25 Mozaffarian D, Shi P, Morris JS. , et al. Mercury exposure and risk of cardiovascular disease in two U.S. cohorts. N Engl J Med 2011; 364 (12) 1116-1125
    CrossrefPubMedGoogle Scholar
  • 26 Mozaffarian D. Fish, mercury, selenium and cardiovascular risk: current evidence and unanswered questions. Int J Environ Res Public Health 2009; 6 (06) 1894-1916
    CrossrefPubMedGoogle Scholar
  • 27 Salonen JT, Seppänen K, Nyyssönen K. , et al. Intake of mercury from fish, lipid peroxidation, and the risk of myocardial infarction and coronary, cardiovascular, and any death in eastern Finnish men. Circulation 1995; 91 (03) 645-655
    CrossrefPubMedGoogle Scholar
  • 28 Guallar E, Sanz-Gallardo MI, van't Veer P. , et al; Heavy Metals and Myocardial Infarction Study Group. Mercury, fish oils, and the risk of myocardial infarction. N Engl J Med 2002; 347 (22) 1747-1754
    CrossrefPubMedGoogle Scholar
  • 29 Salonen JT, Seppänen K, Lakka TA, Salonen R, Kaplan GA. Mercury accumulation and accelerated progression of carotid atherosclerosis: a population-based prospective 4-year follow-up study in men in eastern Finland. Atherosclerosis 2000; 148 (02) 265-273
    CrossrefPubMedGoogle Scholar
  • 30 Moon KA, Guallar E, Umans JG. , et al. Association between exposure to low to moderate arsenic levels and incident cardiovascular disease. A prospective cohort study. Ann Intern Med 2013; 159 (10) 649-659
    PubMedGoogle Scholar
  • 31 Woodward M, Lam TH, Barzi F. , et al; Asia Pacific Cohort Studies Collaboration. Smoking, quitting, and the risk of cardiovascular disease among women and men in the Asia-Pacific region. Int J Epidemiol 2005; 34 (05) 1036-1045
    CrossrefPubMedGoogle Scholar
  • 32 Bhat VM, Cole JW, Sorkin JD. , et al. Dose-response relationship between cigarette smoking and risk of ischemic stroke in young women. Stroke 2008; 39 (09) 2439-2443
    CrossrefPubMedGoogle Scholar
  • 33 Shah RS, Cole JW. Smoking and stroke: the more you smoke the more you stroke. Expert Rev Cardiovasc Ther 2010; 8 (07) 917-932
    CrossrefPubMedGoogle Scholar
  • 34 Nakamura K, Barzi F, Lam TH. , et al; Asia Pacific Cohort Studies Collaboration. Cigarette smoking, systolic blood pressure, and cardiovascular diseases in the Asia-Pacific region. Stroke 2008; 39 (06) 1694-1702
    CrossrefPubMedGoogle Scholar
  • 35 Kawachi I, Colditz GA, Stampfer MJ. , et al. Smoking cessation and decreased risk of stroke in women. JAMA 1993; 269 (02) 232-236
    CrossrefPubMedGoogle Scholar
  • 36 Lin MP, Ovbiagele B, Markovic D, Towfighi A. Association of secondhand smoke with stroke outcomes. Stroke 2016; 47 (11) 2828-2835
    CrossrefPubMedGoogle Scholar
  • 37 Reynolds K, Lewis B, Nolen JD, Kinney GL, Sathya B, He J. Alcohol consumption and risk of stroke: a meta-analysis. JAMA 2003; 289 (05) 579-588
    CrossrefPubMedGoogle Scholar
  • 38 Baliunas DO, Taylor BJ, Irving H. , et al. Alcohol as a risk factor for type 2 diabetes: A systematic review and meta-analysis. Diabetes Care 2009; 32 (11) 2123-2132
    CrossrefPubMedGoogle Scholar
  • 39 Kodama S, Saito K, Tanaka S. , et al. Alcohol consumption and risk of atrial fibrillation: a meta-analysis. J Am Coll Cardiol 2011; 57 (04) 427-436
    CrossrefPubMedGoogle Scholar
  • 40 Briasoulis A, Agarwal V, Messerli FH. Alcohol consumption and the risk of hypertension in men and women: a systematic review and meta-analysis. J Clin Hypertens (Greenwich) 2012; 14 (11) 792-798
    CrossrefPubMedGoogle Scholar
  • 41 Kurth T, Moore SC, Gaziano JM. , et al. Healthy lifestyle and the risk of stroke in women. Arch Intern Med 2006; 166 (13) 1403-1409
    CrossrefPubMedGoogle Scholar
  • 42 Myint PK, Luben RN, Wareham NJ, Bingham SA, Khaw KT. Combined effect of health behaviours and risk of first ever stroke in 20,040 men and women over 11 years' follow-up in Norfolk cohort of European Prospective Investigation of Cancer (EPIC Norfolk): prospective population study. BMJ 2009; 338: b349
    CrossrefPubMedGoogle Scholar
  • 43 Towfighi A, Markovic D, Ovbiagele B. Current national patterns of comorbid diabetes among acute ischemic stroke patients. Cerebrovasc Dis 2012; 33 (05) 411-418
    CrossrefPubMedGoogle Scholar
  • 44 Larsson SC, Wallin A, Wolk A, Markus HS. Differing association of alcohol consumption with different stroke types: a systematic review and meta-analysis. BMC Med 2016; 14 (01) 178
    CrossrefPubMedGoogle Scholar
  • 45 Wood PD, Stefanick ML, Dreon DM. , et al. Changes in plasma lipids and lipoproteins in overweight men during weight loss through dieting as compared with exercise. N Engl J Med 1988; 319 (18) 1173-1179
    CrossrefPubMedGoogle Scholar
  • 46 Sherman DL. Exercise and endothelial function. Coron Artery Dis 2000; 11 (02) 117-122
    CrossrefPubMedGoogle Scholar
  • 47 Koenig W, Sund M, Döring A, Ernst E. Leisure-time physical activity but not work-related physical activity is associated with decreased plasma viscosity. Results from a large population sample. Circulation 1997; 95 (02) 335-341
    CrossrefPubMedGoogle Scholar
  • 48 Ernst E. Regular exercise reduces fibrinogen levels: a review of longitudinal studies. Br J Sports Med 1993; 27 (03) 175-176
    CrossrefPubMedGoogle Scholar
  • 49 Rauramaa R, Salonen JT, Seppänen K. , et al. Inhibition of platelet aggregability by moderate-intensity physical exercise: a randomized clinical trial in overweight men. Circulation 1986; 74 (05) 939-944
    CrossrefPubMedGoogle Scholar
  • 50 Lee CD, Folsom AR, Blair SN. Physical activity and stroke risk: a meta-analysis. Stroke 2003; 34 (10) 2475-2481
    CrossrefPubMedGoogle Scholar
  • 51 Wendel-Vos GC, Schuit AJ, Feskens EJ. , et al. Physical activity and stroke. A meta-analysis of observational data. Int J Epidemiol 2004; 33 (04) 787-798
    CrossrefPubMedGoogle Scholar
  • 52 Gordon NF, Gulanick M, Costa F. , et al; American Heart Association Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention; the Council on Cardiovascular Nursing; the Council on Nutrition, Physical Activity, and Metabolism; and the Stroke Council. Physical activity and exercise recommendations for stroke survivors: An American Heart Association Scientific Statement from the Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention; The Council on Cardiovascular Nursing; The Council on Nutrition, Physical Activity, and Metabolism; and The Stroke Council. Stroke 2004; 35 (05) 1230-1240
    CrossrefPubMedGoogle Scholar
  • 53 Gallanagh S, Quinn TJ, Alexander J, Walters MR. Physical activity in the prevention and treatment of stroke. ISRN Neurol 2011; 2011: 953818
    PubMedGoogle Scholar
  • 54 Billinger SA, Arena R, Bernhardt J. , et al; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Lifestyle and Cardiometabolic Health; Council on Epidemiology and Prevention; Council on Clinical Cardiology. Physical activity and exercise recommendations for stroke survivors: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45 (08) 2532-2553
    CrossrefPubMedGoogle Scholar
  • 55 Kernan WN, Ovbiagele B, Black HR. , et al; American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Peripheral Vascular Disease. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45 (07) 2160-2236
    CrossrefPubMedGoogle Scholar
  • 56 Deijle IA, Van Schaik SM, Van Wegen EE, Weinstein HC, Kwakkel G, Van den Berg-Vos RM. Lifestyle interventions to prevent cardiovascular events after stroke and transient ischemic attack: Systematic review and meta-analysis. Stroke 2017; 48 (01) 174-179
    CrossrefPubMedGoogle Scholar
  • 57 Harrington R, Taylor G, Hollinghurst S, Reed M, Kay H, Wood VA. A community-based exercise and education scheme for stroke survivors: a randomized controlled trial and economic evaluation. Clin Rehabil 2010; 24 (01) 3-15
    CrossrefPubMedGoogle Scholar
  • 58 Huijbregts MP, Myers AM, Streiner D, Teasell R. Implementation, process, and preliminary outcome evaluation of two community programs for persons with stroke and their care partners. Top Stroke Rehabil 2008; 15 (05) 503-520
    CrossrefPubMedGoogle Scholar
  • 59 Lennon O, Carey A, Gaffney N, Stephenson J, Blake C. A pilot randomized controlled trial to evaluate the benefit of the cardiac rehabilitation paradigm for the non-acute ischaemic stroke population. Clin Rehabil 2008; 22 (02) 125-133
    CrossrefPubMedGoogle Scholar
  • 60 Rimmer JH, Riley B, Creviston T, Nicola T. Exercise training in a predominantly African-American group of stroke survivors. Med Sci Sports Exerc 2000; 32 (12) 1990-1996
    CrossrefPubMedGoogle Scholar
  • 61 Rimmer JH, Rauworth AE, Wang EC, Nicola TL, Hill B. A preliminary study to examine the effects of aerobic and therapeutic (nonaerobic) exercise on cardiorespiratory fitness and coronary risk reduction in stroke survivors. Arch Phys Med Rehabil 2009; 90 (03) 407-412
    CrossrefPubMedGoogle Scholar
  • 62 Boysen G, Krarup LH, Zeng X. , et al; ExStroke Pilot Trial Group. ExStroke Pilot Trial of the effect of repeated instructions to improve physical activity after ischaemic stroke: a multinational randomised controlled clinical trial. BMJ 2009; 339: b2810
    CrossrefPubMedGoogle Scholar
  • 63 Dean CM, Rissel C, Sherrington C. , et al. Exercise to enhance mobility and prevent falls after stroke: the community stroke club randomized trial. Neurorehabil Neural Repair 2012; 26 (09) 1046-1057
    CrossrefPubMedGoogle Scholar
  • 64 Duncan PW, Sullivan KJ, Behrman AL. , et al; LEAPS Investigative Team. Body-weight-supported treadmill rehabilitation after stroke. N Engl J Med 2011; 364 (21) 2026-2036
    CrossrefPubMedGoogle Scholar
  • 65 Langhammer B, Lindmark B, Stanghelle JK. Stroke patients and long-term training: is it worthwhile? A randomized comparison of two different training strategies after rehabilitation. Clin Rehabil 2007; 21 (06) 495-510
    CrossrefPubMedGoogle Scholar
  • 66 Lee MJ, Kilbreath SL, Singh MF. , et al. Comparison of effect of aerobic cycle training and progressive resistance training on walking ability after stroke: a randomized sham exercise-controlled study. J Am Geriatr Soc 2008; 56 (06) 976-985
    CrossrefPubMedGoogle Scholar
  • 67 Mudge S, Barber PA, Stott NS. Circuit-based rehabilitation improves gait endurance but not usual walking activity in chronic stroke: a randomized controlled trial. Arch Phys Med Rehabil 2009; 90 (12) 1989-1996
    CrossrefPubMedGoogle Scholar
  • 68 Olney SJ, Nymark J, Brouwer B. , et al. A randomized controlled trial of supervised versus unsupervised exercise programs for ambulatory stroke survivors. Stroke 2006; 37 (02) 476-481
    CrossrefPubMedGoogle Scholar
  • 69 Hu G, Tuomilehto J, Silventoinen K, Sarti C, Männistö S, Jousilahti P. Body mass index, waist circumference, and waist-hip ratio on the risk of total and type-specific stroke. Arch Intern Med 2007; 167 (13) 1420-1427
    CrossrefPubMedGoogle Scholar
  • 70 Strazzullo P, D'Elia L, Cairella G, Garbagnati F, Cappuccio FP, Scalfi L. Excess body weight and incidence of stroke: meta-analysis of prospective studies with 2 million participants. Stroke 2010; 41 (05) e418-e426
    CrossrefPubMedGoogle Scholar
  • 71 Kurth T, Gaziano JM, Rexrode KM. , et al. Prospective study of body mass index and risk of stroke in apparently healthy women. Circulation 2005; 111 (15) 1992-1998
    CrossrefPubMedGoogle Scholar
  • 72 Rexrode KM, Hennekens CH, Willett WC. , et al. A prospective study of body mass index, weight change, and risk of stroke in women. JAMA 1997; 277 (19) 1539-1545
    CrossrefPubMedGoogle Scholar
  • 73 Song YM, Sung J, Davey Smith G, Ebrahim S. Body mass index and ischemic and hemorrhagic stroke: a prospective study in Korean men. Stroke 2004; 35 (04) 831-836
    CrossrefPubMedGoogle Scholar
  • 74 Suk SH, Sacco RL, Boden-Albala B. , et al; Northern Manhattan Stroke Study. Abdominal obesity and risk of ischemic stroke: the Northern Manhattan Stroke Study. Stroke 2003; 34 (07) 1586-1592
    CrossrefPubMedGoogle Scholar
  • 75 Lawlor DA, Leon DA. Association of body mass index and obesity measured in early childhood with risk of coronary heart disease and stroke in middle age: findings from the Aberdeen children of the 1950s prospective cohort study. Circulation 2005; 111 (15) 1891-1896
    CrossrefPubMedGoogle Scholar
  • 76 Chen HJ, Bai CH, Yeh WT, Chiu HC, Pan WH. Influence of metabolic syndrome and general obesity on the risk of ischemic stroke. Stroke 2006; 37 (04) 1060-1064
    CrossrefPubMedGoogle Scholar
  • 77 Buil-Cosiales P, Toledo E, Salas-Salvadó J. , et al; PREDIMED investigators. Association between dietary fibre intake and fruit, vegetable or whole-grain consumption and the risk of CVD: results from the PREvención con DIeta MEDiterránea (PREDIMED) trial. Br J Nutr 2016; 116 (03) 534-546
    CrossrefPubMedGoogle Scholar
  • 78 Kristal A, Sanders P. Role of dietary salt and potassium intake in cardiovascular health and disease: A review of the evidence. Mayo Clin Proc 2013; 88: 987-995
    CrossrefPubMedGoogle Scholar
  • 79 Aune D, Giovannucci E, Boffetta P. , et al. Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality-a systematic review and dose-response meta-analysis of prospective studies. Int J Epidemiol 2017 [Epub ahead of print]
    PubMedGoogle Scholar
  • 80 Towfighi A, Markovic D, Ovbiagele B. Impact of a healthy lifestyle on all-cause and cardiovascular mortality after stroke in the United States. Manuscript submitted for publication
    PubMedGoogle Scholar
  • 81 Ovbiagele B. Pathways and tools of Stroke PROTECT: a hospital-based recurrent stroke prevention program. Crit Pathw Cardiol 2009; 8 (04) 151-155
    CrossrefPubMedGoogle Scholar
  • 82 Glader EL, Sjölander M, Eriksson M, Lundberg M. Persistent use of secondary preventive drugs declines rapidly during the first 2 years after stroke. Stroke 2010; 41 (02) 397-401
    CrossrefPubMedGoogle Scholar
  • 83 Hornnes N, Larsen K, Boysen G. Blood pressure 1 year after stroke: the need to optimize secondary prevention. J Stroke Cerebrovasc Dis 2011; 20 (01) 16-23
    CrossrefPubMedGoogle Scholar
  • 84 Peng W, Yang J, Wang Y. , et al. Systematic review and meta-analysis of randomized controlled trials of xingnaojing treatment for stroke. Evid Based Complement Alternat Med 2014; 2014: 210851
    PubMedGoogle Scholar
  • 85 Feigin VL, Krishnamurthi R, Bhattacharjee R. , et al; RIBURST Study Collaboration Writing Group. New strategy to reduce the global burden of stroke. Stroke 2015; 46 (06) 1740-1747
    CrossrefPubMedGoogle Scholar
  • 86 Parmar P, Krishnamurthi R, Ikram MA. , et al; Stroke RiskometerTM Collaboration Writing Group. The Stroke Riskometer(TM) App: validation of a data collection tool and stroke risk predictor. Int J Stroke 2015; 10 (02) 231-244
    CrossrefPubMedGoogle Scholar
  • 87 Feigin VL, Norrving B. A new paradigm for primary prevention strategy in people with elevated risk of stroke. Int J Stroke 2014; 9 (05) 624-626
    CrossrefPubMedGoogle Scholar
  • 88 Campbell M, Fitzpatrick R, Haines A. , et al. Framework for design and evaluation of complex interventions to improve health. BMJ 2000; 321 (7262): 694-696
    CrossrefPubMedGoogle Scholar
  • 89 Dickinson HO, Mason JM, Nicolson DJ. , et al. Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials. J Hypertens 2006; 24 (02) 215-233
    CrossrefPubMedGoogle Scholar
  • 90 Norris SL, Engelgau MM, Narayan KM. Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care 2001; 24 (03) 561-587
    CrossrefPubMedGoogle Scholar
  • 91 Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 1977; 84 (02) 191-215
    CrossrefPubMedGoogle Scholar
  • 92 Bandura A. Self-efficacy: The exercise of control. New York: W. H. Freeman; 1997
    Google Scholar
  • 93 Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol 1983; 51 (03) 390-395
    CrossrefPubMedGoogle Scholar
  • 94 Fishbein M, Ajzen I. Theory-based behavior change interventions: comments on Hobbis and Sutton. J Health Psychol 2005; 10 (01) 27-31 , discussion 37–43
    CrossrefPubMedGoogle Scholar
  • 95 Bandura A. Health promotion by social cognitive means. Health Educ Behav 2004; 31 (02) 143-164
    CrossrefPubMedGoogle Scholar
  • 96 House JS. Social support and social structure. Sociological Forum 1987; 2: 135-146
    CrossrefPubMedGoogle Scholar
  • 97 Cohen S, Underwood LG, Gottlieb BH. Social support measurement and intervention. New York: Oxford University Press; 2000
    Google Scholar
  • 98 Glanz K, Rimer BK, Viswanath K. Health behavior and health education: Theory, research, and practice. San Francisco, CA: Wiley; 2008
    Google Scholar
  • 99 Kono Y, Yamada S, Yamaguchi J. , et al. Secondary prevention of new vascular events with lifestyle intervention in patients with noncardioembolic mild ischemic stroke: a single-center randomized controlled trial. Cerebrovasc Dis 2013; 36 (02) 88-97
    CrossrefPubMedGoogle Scholar
  • 100 Evans-Hudnall GL, Stanley MA, Clark AN. , et al. Improving secondary stroke self-care among underserved ethnic minority individuals: a randomized clinical trial of a pilot intervention. J Behav Med 2014; 37 (02) 196-204
    CrossrefPubMedGoogle Scholar
  • 101 Kronish IM, Goldfinger JZ, Negron R. , et al. Effect of peer education on stroke prevention: the prevent recurrence of all inner-city strokes through education randomized controlled trial. Stroke 2014; 45 (11) 3330-3336
    CrossrefPubMedGoogle Scholar
  • 102 Allen KR, Hazelett S, Jarjoura D. , et al. Effectiveness of a postdischarge care management model for stroke and transient ischemic attack: a randomized trial. J Stroke Cerebrovasc Dis 2002; 11 (02) 88-98
    CrossrefPubMedGoogle Scholar
  • 103 Allen K, Hazelett S, Jarjoura D. , et al. A randomized trial testing the superiority of a postdischarge care management model for stroke survivors. J Stroke Cerebrovasc Dis 2009; 18 (06) 443-452
    CrossrefPubMedGoogle Scholar
  • 104 Barker-Collo S, Krishnamurthi R, Witt E. , et al. Improving adherence to secondary stroke prevention strategies through motivational interviewing: Randomized controlled trial. Stroke 2015; 46 (12) 3451-3458
    CrossrefPubMedGoogle Scholar
  • 105 Brotons C, Soriano N, Moral I. , et al; PREseAP study research team. Randomized clinical trial to assess the efficacy of a comprehensive programme of secondary prevention of cardiovascular disease in general practice: the PREseAP study. Rev Esp Cardiol 2011; 64 (01) 13-20
    PubMedGoogle Scholar
  • 106 Brown DL, Conley KM, Resnicow K. , et al. Stroke Health and Risk Education (SHARE): design, methods, and theoretical basis. Contemp Clin Trials 2012; 33 (04) 721-729
    CrossrefPubMedGoogle Scholar
  • 107 Dromerick AW, Gibbons MC, Edwards DF. , et al. Preventing recurrence of thromboembolic events through coordinated treatment in the District of Columbia. Int J Stroke 2011; 6 (05) 454-460
    CrossrefPubMedGoogle Scholar
  • 108 Ellis G, Rodger J, McAlpine C, Langhorne P. The impact of stroke nurse specialist input on risk factor modification: a randomised controlled trial. Age Ageing 2005; 34 (04) 389-392
    CrossrefPubMedGoogle Scholar
  • 109 Gillham S, Endacott R. Impact of enhanced secondary prevention on health behaviour in patients following minor stroke and transient ischaemic attack: a randomized controlled trial. Clin Rehabil 2010; 24 (09) 822-830
    CrossrefPubMedGoogle Scholar
  • 110 Green T, Haley E, Eliasziw M, Hoyte K. Education in stroke prevention: efficacy of an educational counselling intervention to increase knowledge in stroke survivors. Can J Neurosci Nurs 2007; 29 (02) 13-20
    PubMedGoogle Scholar
  • 111 Irewall AL, Ögren J, Bergström L, Laurell K, Söderström L, Mooe T. Nurse-led, telephone-based, secondary preventive follow-up after stroke or transient ischemic attack improves blood pressure and LDL cholesterol: Results from the first 12 months of the randomized, controlled nailed stroke risk factor trial. PLoS One 2015; 10 (10) e0139997
    CrossrefPubMedGoogle Scholar
  • 112 Joubert J, Reid C, Barton D. , et al. Integrated care improves risk-factor modification after stroke: initial results of the Integrated Care for the Reduction of Secondary Stroke model. J Neurol Neurosurg Psychiatry 2009; 80 (03) 279-284
    CrossrefPubMedGoogle Scholar
  • 113 Kamal AK, Shaikh Q, Pasha O. , et al. A randomized controlled behavioral intervention trial to improve medication adherence in adult stroke patients with prescription tailored Short Messaging Service (SMS)-SMS4Stroke study. BMC Neurol 2015; 15: 212
    CrossrefPubMedGoogle Scholar
  • 114 Lennon O, Blake C. Cardiac rehabilitation adapted to transient ischaemic attack and stroke (CRAFTS): a randomised controlled trial. BMC Neurol 2009; 9: 9
    CrossrefPubMedGoogle Scholar
  • 115 Lord AS, Carman HM, Roberts ET. , et al. Discharge educational strategies for reduction of vascular events (DESERVE): design and methods. Int J Stroke 2015; 10 (Suppl A100): 151-154
    CrossrefPubMedGoogle Scholar
  • 116 Maasland L, van Oostenbrugge RJ, Franke CF, Scholte Op Reimer WJ, Koudstaal PJ, Dippel DW. ; Netherlands Stroke Survey Investigators. Patients enrolled in large randomized clinical trials of antiplatelet treatment for prevention after transient ischemic attack or ischemic stroke are not representative of patients in clinical practice: the Netherlands Stroke Survey. Stroke 2009; 40 (08) 2662-2668
    CrossrefPubMedGoogle Scholar
  • 117 McManus JA, Craig A, McAlpine C, Langhorne P, Ellis G. Does behaviour modification affect post-stroke risk factor control? Three-year follow-up of a randomized controlled trial. Clin Rehabil 2009; 23 (02) 99-105
    CrossrefPubMedGoogle Scholar
  • 118 Rimmer JH, Braunschweig C, Silverman K, Riley B, Creviston T, Nicola T. Effects of a short-term health promotion intervention for a predominantly African-American group of stroke survivors. Am J Prev Med 2000; 18 (04) 332-338
    CrossrefPubMedGoogle Scholar
  • 119 Spassova L, Vittore D, Droste DW, Rösch N. Randomised controlled trial to evaluate the efficacy and usability of a computerised phone-based lifestyle coaching system for primary and secondary prevention of stroke. BMC Neurol 2016; 16: 22
    CrossrefPubMedGoogle Scholar
  • 120 van der Ploeg HP, Streppel KR, van der Beek AJ. , et al. Successfully improving physical activity behavior after rehabilitation. Am J Health Promot 2007; 21 (03) 153-159
    CrossrefPubMedGoogle Scholar
  • 121 Wolfe CD, Redfern J, Rudd AG, Grieve AP, Heuschmann PU, McKevitt C. Cluster randomized controlled trial of a patient and general practitioner intervention to improve the management of multiple risk factors after stroke: stop stroke. Stroke 2010; 41 (11) 2470-2476
    CrossrefPubMedGoogle Scholar
  • 122 Lennon S, McKenna S, Jones F. Self-management programmes for people post stroke: a systematic review. Clin Rehabil 2013; 27 (10) 867-878
    CrossrefPubMedGoogle Scholar
  • 123 Pearce G, Pinnock H, Epiphaniou E. , et al. Experiences of self-management support following a stroke: A meta-review of qualitative systematic reviews. PLoS One 2015; 10 (12) e0141803
    CrossrefPubMedGoogle Scholar
  • 124 Lorig KR, Sobel DS, Stewart AL. , et al. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Med Care 1999; 37 (01) 5-14
    CrossrefPubMedGoogle Scholar
  • 125 Lorig KR, Sobel DS, Ritter PL, Laurent D, Hobbs M. Effect of a self-management program on patients with chronic disease. Eff Clin Pract 2001; 4 (06) 256-262
    PubMedGoogle Scholar
  • 126 Sakakibara BM, Kim AJ, Eng JJ. A systematic review and meta-analysis on self-management for improving risk factor control in stroke patients. Int J Behav Med 2017; 24 (01) 42-53
    CrossrefPubMedGoogle Scholar
  • 127 Maasland E, Koudstaal PJ, Habbema JD, Dippel DW. Effects of an individualized multimedia computer program for health education in patients with a recent minor stroke or transient ischemic attack - a randomized controlled trial. Acta Neurol Scand 2007; 115 (01) 41-48
    PubMedGoogle Scholar
  • 128 Miller WR, Yahne CE, Tonigan JS. Motivational interviewing in drug abuse services: a randomized trial. J Consult Clin Psychol 2003; 71 (04) 754-763
    CrossrefPubMedGoogle Scholar
  • 129 Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health 2014; 35: 399-421
    CrossrefPubMedGoogle Scholar
  • 130 Viswanathan M, Kraschnewski JL, Nishikawa B. , et al. Outcomes and costs of community health worker interventions: a systematic review. Med Care 2010; 48 (09) 792-808
    CrossrefPubMedGoogle Scholar
  • 131 Lager KE, Mistri AK, Khunti K, Haunton VJ, Sett AK, Wilson AD. Interventions for improving modifiable risk factor control in the secondary prevention of stroke. Cochrane Database Syst Rev 2014; (05) CD009103
    PubMedGoogle Scholar
  • 132 Chiu CC, Wu SS, Lee PY, Huang YC, Tan TY, Chang KC. Control of modifiable risk factors in ischemic stroke outpatients by pharmacist intervention: an equal allocation stratified randomized study. J Clin Pharm Ther 2008; 33 (05) 529-535
    CrossrefPubMedGoogle Scholar
  • 133 Flemming KD, Allison TG, Covalt JL, Herzig DE, Brown RD. Utility of a post-hospitalization stroke prevention program managed by nurses. Hosp Pract (1995) 2013; 41 (03) 70-79
    CrossrefPubMedGoogle Scholar
  • 134 Welin L, Bjälkefur K, Roland I. Open, randomized pilot study after first stroke: a 3.5-year follow-up. Stroke 2010; 41 (07) 1555-1557
    CrossrefPubMedGoogle Scholar
  • 135 Johnston SC, Sidney S, Hills NK. , et al. Standardized discharge orders after stroke: results of the quality improvement in stroke prevention (QUISP) cluster randomized trial. Ann Neurol 2010; 67 (05) 579-589
    PubMedGoogle Scholar
  • 136 Eames S, Hoffmann T, Worrall L, Read S, Wong A. Randomised controlled trial of an education and support package for stroke patients and their carers. BMJ Open 2013; 3 (05) 3
    CrossrefPubMedGoogle Scholar
  • 137 Lowe DB, Sharma AK, Leathley MJ. The CareFile Project: a feasibility study to examine the effects of an individualised information booklet on patients after stroke. Age Ageing 2007; 36 (01) 83-89
    PubMedGoogle Scholar
  • 138 Boter H. ; HESTIA Study Group. Multicenter randomized controlled trial of an outreach nursing support program for recently discharged stroke patients. Stroke 2004; 35 (12) 2867-2872
    CrossrefPubMedGoogle Scholar
  • 139 O'Carroll R, Whittaker J, Hamilton B, Johnston M, Sudlow C, Dennis M. Predictors of adherence to secondary preventive medication in stroke patients. Ann Behav Med 2011; 41 (03) 383-390
    CrossrefPubMedGoogle Scholar