Non-Pharmacological Interventions for Primary Stroke Prevention: A Systematic Review

Abstract

Background: Stroke remains a leading cause of disability and mortality globally, highlighting the need for effective primary prevention. While pharmacological treatments are well-established, non-pharmacological interventions (such as lifestyle modifications) are gaining prominence due to their potential for safer, sustainable stroke risk reduction.

Objectives: This systematic review examines both non-pharmacological and pharmacological interventions for primary stroke prevention, evaluating their effectiveness in reducing stroke risk and improving cardiovascular health in at-risk populations.

Methods: A systematic review was conducted following PRISMA guidelines. Searches were performed across seven databases (ScienceDirect, Scopus, ProQuest, EBSCOhost, SAGE Journals, Taylor & Francis, and PubMed) for studies published between 2019 and 2024. Inclusion criteria focused on randomized controlled trials, cohort studies, and quasi-experimental research involving adults at risk for stroke. Data were extracted on intervention type, duration, outcomes, and study quality, with assessments conducted using the Joanna Briggs Institute (JBI) and Risk-Of-Bias VISualization (ROBVIS) tools for non-randomized and randomized studies, respectively.

Results: From 20,971 screened studies, twelve met the inclusion criteria. Non-pharmacological interventions, including exercise, dietary changes, smoking cessation, and behavioral counseling, showed promising results in reducing stroke incidence and improving cardiovascular health markers such as blood pressure and cholesterol levels. Pharmacological treatments demonstrated efficacy in patients with high-risk profiles but had limitations due to potential side effects and adherence issues. Combined approaches integrating lifestyle modifications with standard medical care may offer the most effective strategy for sustained stroke prevention.

Conclusion: Non-pharmacological interventions are a valuable component of primary stroke prevention, providing a patient-centered approach with fewer adverse effects compared to pharmacological options. Further research is needed to optimize combined intervention strategies and to expand the evidence base for non- pharmacological approaches in diverse populations.