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.