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成人における脳卒中予防のための非薬理学的介入の比較効果：ネットワークメタアナリシス

Nhuan Quang Nguyen, Kim-Ngan Thi Ta, Kai-Jen Chuang

Cerebrovascular diseases (Basel, Switzerland)

|January 30, 2026

要旨

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 673624 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, while Salt substitute had long-term effects on reducing 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 risk. Vitamin B6 + B12 + folic acid may lower hemorrhagic stroke, fatal 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.

キーワード:

脳卒中予防非薬理学的介入ネットワークメタアナリシス運動食事サプリメント塩分代替物

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