Cardiac Rehab Can Help Prevent a Stroke after a TIA

If someone has a transient ischemic attack or TIA – also called a mini-stroke – they are at a seriously increased risk of having a full-blown stroke within a brief period.  Apart from lifestyle changes (diet, exercise, etc.) it seems that participation in a comprehensive cardiac rehabilitation program can help prevent the occurrence of a full-blown stroke.  This as the conclusion of a study from Canada reported in the journal Stroke.

Consecutive TIA or mild, non-disabling stroke subjects within the previous 12 months and having one or more cardiovascular risk factors were recruited from a stroke-prevention clinic.  Basic secondary prevention at stroke-prevention clinics typically includes only medications and fairly low-intensity counseling on risk factors, with referral to other sources for exercise and dietary programs.  In this study, 100 patients undertook comprehensive cardiac rehabilitation (CCR); they joined heart patients in a 6-month outpatient program that included education, depression screening and referral, smoking cessation program 9if appropriate), and nutritional counseling emphasizing the Mediterranean diet.  They exercised 4 times a week, on-site or with follow-up at home or both.  Medical management followed clinical guidelines.   

Eighty of the 100 participants completed the 6-month program.  There were significant average changes from baseline: a 31% increase in aerobic capacity, significant drops in total cholesterol and total to high-density lipoprotein cholesterol ratio, a decrease in triglycerides, loss of almost an inch in waist circumference (2.44 cm), 3.15 pounds loss in weight, a 0.53 kg/m² fall in BMI, and 7 of 14 smokers had quit. Systolic and diastolic blood pressure decreased by 3.21 mm Hg and 2.34 mm Hg, respectively.  Overall, the annualized rate of stroke recurrence was 4.6%, which is at the lower end of published risk estimates for this population.  There were no strokes in the 80 ‘completers’ during the 6-month study period.

Of course, with a control group this trial cannot be used as evidence that CCR is beneficial for TIA and mild stroke patients, but the findings point strongly in that direction.  The authors of the study state that a randomized trial is now under way, to satisfy this requirement.  TIA patients shouldn’t wait, though; they should ask their doctors to refer them to a comprehensive stroke-prevention program, or a cardiovascular rehabilitation program.  After all, TIAs are a risk factor for heart attack, too.