title: Guideline-directed low-density lipoprotein management in high-risk patients with ischemic stroke: findings from Get with the Guidelines-Stroke 2003 to 2012.
abstract: OBJECTIVE
  Limited information is available on stroke prevention in high-risk patients with preexisting cardiovascular disease. Our aim was to use admission low-density lipoprotein (LDL) values to evaluate differences in the attainment of National Cholesterol Education Program-Adult Treatment Panel III guidelines goals at the time of the index event in high-risk patients with stroke and preexisting cardio- or cerebrovascular disease.
  
  
  METHODS
  Observational study, using data from the Get-With-The-Guidelines-Stroke Registry including 913 436 patients with an acute ischemic stroke or transient ischemic attack from April 2003 to September 2012. Participants were classified as high risk if they had history of transient ischemic attack (TIA), stroke (cardiovascular disease), and coronary artery disease (CAD).
  
  
  RESULTS
  Of the 913 436 patients admitted with an acute stroke or TIA, 194 557 (21.3%) had previous stroke/TIA, 148 833 (16.3%) had previous CAD, and 88 605 (9.7%) had concomitant CAD and cardiovascular disease. Overall, only 68% of patients with stroke were at their preadmission National Cholesterol Education Program III guideline-recommended LDL target; 51.3% had LDL <100 mg/dL; and only 19.8% had LDL<70 mg/dL. Among those presenting with a recurrent stroke, >45% had LDL>100 mg/dL. When compared with patients with CAD, patients with previous TIA/stroke were less likely to have LDL<100 or <70 mg/dL. In multivariable analysis, older age, men, white race, lack of major vascular risk factors, previous use of cholesterol-lowering therapy, and care provided in larger hospitals were associated with meeting LDL targets on admission testing.
  
  
  CONCLUSIONS
  Management of dyslipidemia in high-risk patients with preexistent CAD or stroke continues to be suboptimal. Only 1 in 5 patients with prior TIA/stroke had LDL levels <70 mg/dL.
authors.affiliation: From the Division of Neurology, Department of Medicine, Stroke Outcomes Research Center, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (G.S.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Duke Clinical Research Institute, Durham, NC (W.P., L.L., A.F.H.); Stroke Service and Institute for Heart, Vascular and Stroke Care, Massachusetts General Hospital, Boston (L.H.S.); and Calgary Stroke Program, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.). saposnikg@smh.ca.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Saposnik
authors.affiliation: From the Division of Neurology, Department of Medicine, Stroke Outcomes Research Center, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (G.S.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Duke Clinical Research Institute, Durham, NC (W.P., L.L., A.F.H.); Stroke Service and Institute for Heart, Vascular and Stroke Care, Massachusetts General Hospital, Boston (L.H.S.); and Calgary Stroke Program, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.).
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: From the Division of Neurology, Department of Medicine, Stroke Outcomes Research Center, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (G.S.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Duke Clinical Research Institute, Durham, NC (W.P., L.L., A.F.H.); Stroke Service and Institute for Heart, Vascular and Stroke Care, Massachusetts General Hospital, Boston (L.H.S.); and Calgary Stroke Program, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.).
authors.forename: Wenquin
authors.initials: W
authors.lastname: Pan
authors.affiliation: From the Division of Neurology, Department of Medicine, Stroke Outcomes Research Center, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (G.S.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Duke Clinical Research Institute, Durham, NC (W.P., L.L., A.F.H.); Stroke Service and Institute for Heart, Vascular and Stroke Care, Massachusetts General Hospital, Boston (L.H.S.); and Calgary Stroke Program, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.).
authors.forename: Li
authors.initials: L
authors.lastname: Liang
authors.affiliation: From the Division of Neurology, Department of Medicine, Stroke Outcomes Research Center, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (G.S.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Duke Clinical Research Institute, Durham, NC (W.P., L.L., A.F.H.); Stroke Service and Institute for Heart, Vascular and Stroke Care, Massachusetts General Hospital, Boston (L.H.S.); and Calgary Stroke Program, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.).
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: From the Division of Neurology, Department of Medicine, Stroke Outcomes Research Center, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (G.S.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Duke Clinical Research Institute, Durham, NC (W.P., L.L., A.F.H.); Stroke Service and Institute for Heart, Vascular and Stroke Care, Massachusetts General Hospital, Boston (L.H.S.); and Calgary Stroke Program, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.).
authors.forename: Lee H
authors.initials: LH
authors.lastname: Schwamm
authors.affiliation: From the Division of Neurology, Department of Medicine, Stroke Outcomes Research Center, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (G.S.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Duke Clinical Research Institute, Durham, NC (W.P., L.L., A.F.H.); Stroke Service and Institute for Heart, Vascular and Stroke Care, Massachusetts General Hospital, Boston (L.H.S.); and Calgary Stroke Program, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.).
authors.forename: Eric E
authors.initials: EE
authors.lastname: Smith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000097:blood* / Q000453:epidemiology / Q000628:therapy; D008078:Cholesterol, LDL / Q000097:blood*; D019468:Disease Management; D050171:Dyslipidemias / Q000097:blood* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D012042:Registries / Q000592:standards; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000453:epidemiology / Q000628:therapy
chemical_list: D008078:Cholesterol, LDL
keywords: LDL cholesterol; cardiovascular diseases; cholesterol; diabetes mellitus; dyslipidemias; prevention & control; standards; stroke; therapeutics