Dorien Brouwer

92 Chapter 2.1 PART 2 Table 1 : The estimated relative risk reduction on modifiable risk factors by health education for major vascular events in patients with TIA or ischemic stroke. Data from cohort studies or RCT’s in patients with a recent TIA or ischemic stroke Risk factor Typical value in a stroke or TIA patient Optimal value Difference Estimated relative risk reducation 1 Source BMI (kg/m 2 ) 3 28 22 6 30% Cohort studies (82, 83) Smoking behavior (nr/day) 10 0 10 22% Cohort studies (82, 83) Cholesterol (mmol/l) 5.9 4.5 1.4 25-33% 2 RCT 4 (84, 85) LDL cholesterol (mml/l) 3.4 2.5 1.0 25-33% 2 RCT 4 (84,85) Blood pressure (mmHg) 130/80 120/75 10/5 25% RCT 4 (86) Physical activity (minutes/ day) <10 >30 >20 21% Cohort studies (82, 83) 1 Not adjusted for the other risk factors 2 if the compliance for statins is optimal 3 Body Mass Index 4 Randomized controlled trial The estimated relative risk reduction that can be achieved by adequate HE on top of the standard medical treatment ranges from 21% to 30% per separate risk factor. One has to take into account that this is a theoretical maximal effect. Moreover, there will be interaction between the risk factors; for example, reducing weight by increasing physical activity will also reduce the blood pressure. However, the effect of adequate HE can still be considerable. Health education is important for a number of reasons. [8] First, with the current regime of medication, like antiplatelet drugs, antidiabetica, lipid-lowering and antihypertensive drugs, physicians try to reduce the risk of a recurrent vascular event in stroke and TIA patients. Compliance with the pharmacological therapy is essential for the effectiveness of secondary prevention, but this is not optimal in stroke and TIA patients. [9] Health education could improve risk reduction by promoting compliance and healthy behavior. Second, it aims to improve patients and caregivers’ understanding of their health status and treatment options. Third, HE should facilitate interactive communication between health provider and patient, and enhance patient participation in continuing care. Fourth, HE is considered necessary for prevention, because it is assumed that the more people know about their disease and associated risk factors, the more they could be willing to change their behavior in order to reduce the risk of future events. However, although patients with stroke and TIA already have had at least one vascular event, this does not automatically result in changes in health behavior to reduce their risk of a recurrent vascular event. Health education in stroke and TIA patients needs special consideration, because these patients have a few disadvantages in comparison with other vascular patients. They are generally older; patients with stroke are on average 5–10-years older than patients with acute coronary syndrome at the time of their event. [10, 11] Disability