Guidelines for Management of Hyperlipidemia: Implications for Treatment of Patients with Stroke Secondary to Atherosclerotic Disease

Current Neurology and Neuroscience Reports
Sudeepta Dandapat, Jennifer G Robinson

Abstract

After careful review of randomized cardiovascular outcomes trial data, the 2013 ACC/AHA cholesterol guideline focused on using the appropriate intensity of statin therapy to reduce atherosclerotic cardiovascular disease (ASCVD) risk and moved away from recommending specific low-density lipoprotein cholesterol (LDL-C) treatment targets. In patients who have had a stroke or other clinical ASCVD event, a high-intensity statin should be initiated up to age 75 years unless there are safety concerns, including a history of hemorrhagic stroke. A moderate-intensity statin is recommended if there are safety concerns or age is greater than 75 years. Atorvastatin 40-80 mg and rosuvastatin 20-40 mg are considered high-intensity statins. These new guidelines avoid unnecessary usage of non-statins to achieve specific LDL-C values, thus avoiding potential adverse effects or use of an inadequate statin intensity in patients who are "at goal." When non-statins are considered for additional LDL-C lowering, ezetimibe is the only non-statin clearly shown to further reduce ASCVD risk when added to background statin therapy.

References

Dec 1, 1992·Acta Neurologica Scandinavica·A LindgrenB B Johansson
Apr 1, 1989·Stroke; a Journal of Cerebral Circulation·R J AdamsW O Thompson
Dec 5, 1998·The New England Journal of Medicine·UNKNOWN Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group
Jun 22, 2002·JAMA : the Journal of the American Medical Association·Patrick W J C SerruysUNKNOWN Lescol Intervention Prevention Study (LIPS) Investigators
Nov 7, 2002·The American Journal of Cardiology·Scott M Grundy, UNKNOWN National Cholesterol Education Program (NCEP)-The National Cholesterol Guidelines in 2001, Adult Treatment Panel (ATP) III
Mar 10, 2004·The New England Journal of Medicine·Christopher P CannonUNKNOWN Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 Investigators
Nov 9, 2004·Atherosclerosis. Supplements·T R PedersenUNKNOWN Scandinavian Simvastatin Survival Study Group
Mar 10, 2005·The New England Journal of Medicine·John C LaRosaUNKNOWN Treating to New Targets (TNT) Investigators
Jul 22, 2005·The New England Journal of Medicine·Christoph WannerUNKNOWN German Diabetes and Dialysis Study Investigators
Nov 16, 2005·Journal of the American College of Cardiology·Jennifer G RobinsonHelmut Schrott
Nov 17, 2005·JAMA : the Journal of the American Medical Association·Terje R PedersenUNKNOWN Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) Study Group
Apr 4, 2006·The American Journal of Cardiology·David E CohenUNKNOWN National Lipid Association Statin Safety Task Force Liver Expert Panel
Apr 18, 2006·The American Journal of Cardiology·Tomohiro SakamotoUNKNOWN Multicenter Study for Aggressive Lipid-Lowering Strategy by HMG-CoA Reductase Inhibitors in Patients With Acute Myocardial I
Aug 11, 2006·The New England Journal of Medicine·Pierre AmarencoUNKNOWN Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators
Nov 7, 2007·The New England Journal of Medicine·Philip J BarterUNKNOWN ILLUMINATE Investigators
Nov 7, 2007·The New England Journal of Medicine·John KjekshusUNKNOWN CORONA Group
Dec 14, 2007·Neurology·L B GoldsteinUNKNOWN SPARCL Investigators
Nov 11, 2008·The New England Journal of Medicine·Paul M RidkerUNKNOWN JUPITER Study Group
Jan 24, 2009·Journal of the American College of Cardiology·Jennifer G RobinsonTerry A Jacobson
Feb 21, 2009·Stroke; a Journal of Cerebral Circulation·Pierre AmarencoUNKNOWN Stroke Prevention by Aggressive Reduction in Cholesterol Levels Investigators
Apr 1, 2009·The New England Journal of Medicine·Bengt C FellströmUNKNOWN AURORA Study Group
Mar 17, 2010·The New England Journal of Medicine·Henry N GinsbergRobert P Byington
Jun 23, 2011·JAMA : the Journal of the American Medical Association·David PreissKausik K Ray
Oct 25, 2011·Stroke; a Journal of Cerebral Circulation·Alexander C FlintS Claiborne Johnston
Nov 17, 2011·The New England Journal of Medicine·William E BodenWilliam Weintraub
Feb 4, 2012·Journal of the American College of Cardiology·William J KostisJohn B Kostis
Mar 24, 2012·Stroke; a Journal of Cerebral Circulation·Dar DowlatshahiUNKNOWN Registry of the Canadian Stroke Network
May 17, 2012·Stroke; a Journal of Cerebral Circulation·James S McKinney, William J Kostis

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Citations

Oct 29, 2020·SAGE Open Medicine·Madeline R MacDonaldAbu-Sayeef Mirza

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