title: Guidelines for Management of Hyperlipidemia: Implications for Treatment of Patients with Stroke Secondary to Atherosclerotic Disease.
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.
authors.affiliation: Department of Neurology, University of Iowa, Iowa City, IA, USA.
authors.forename: Sudeepta
authors.initials: S
authors.lastname: Dandapat
authors.affiliation: Departments of Epidemiology & Medicine, Prevention Intervention Center, College of Public Health, University of Iowa, 145 N Riverside Drive S455 CPHB, Iowa City, IA, 52242-2007, USA. jennifer-g-robinson@uiowa.edu.
authors.forename: Jennifer G
authors.initials: JG
authors.lastname: Robinson
mesh_terms: D050197:Atherosclerosis / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006949:Hyperlipidemias / Q000150:complications / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Cardiovascular prevention; Cholesterol; Hemorrhagic stroke; Ischemic stroke; Statins
references.citation: N Engl J Med. 1995 Nov 16;333(20):1301-7
references.pmid: 7566020
references.citation: Curr Opin Lipidol. 2015 Jun;26(3):228-35
references.pmid: 25887679
references.citation: Stroke. 1993 Jul;24(7):954-64
references.pmid: 8322395
references.citation: N Engl J Med. 2006 Aug 10;355(6):549-59
references.pmid: 16899775
references.citation: Stroke. 2012 Jan;43(1):147-54
references.pmid: 22020026
references.citation: N Engl J Med. 2011 Dec 15;365(24):2255-67
references.pmid: 22085343
references.citation: JAMA. 1998 May 27;279(20):1615-22
references.pmid: 9613910
references.citation: JAMA. 2011 Jun 22;305(24):2556-64
references.pmid: 21693744
references.citation: BMC Cardiovasc Disord. 2014 Nov 20;14:163
references.pmid: 25410585
references.citation: Am J Cardiol. 2002 Oct 17;90(8A):11i-21i
references.pmid: 12419477
references.citation: Lancet. 2015 Apr 11;385(9976):1397-405
references.pmid: 25579834
references.citation: N Engl J Med. 1996 Oct 3;335(14):1001-9
references.pmid: 8801446
references.citation: Am J Cardiol. 2008 Apr 1;101(7):1009-15
references.pmid: 18359323
references.citation: Lancet. 2004 Aug 21-27;364(9435):685-96
references.pmid: 15325833
references.citation: Stroke. 2012 Aug;43(8):2149-56
references.pmid: 22588266
references.citation: J Am Coll Cardiol. 2009 Jan 27;53(4):316-22
references.pmid: 19161879
references.citation: Circulation. 2002 Dec 17;106(25):3143-421
references.pmid: 12485966
references.citation: Stroke. 2009 Apr;40(4):1405-9
references.pmid: 19228842
references.citation: N Engl J Med. 2007 Nov 22;357(21):2109-22
references.pmid: 17984165
references.citation: Lancet. 2010 Nov 13;376(9753):1670-81
references.pmid: 21067804
references.citation: Lancet. 2006 Sep 30;368(9542):1155-63
references.pmid: 17011942
references.citation: JAMA. 2014 Apr 9;311(14):1406-15
references.pmid: 24682252
references.citation: Stroke. 1989 Apr;20(4):448-52
references.pmid: 2929024
references.citation: JAMA. 2002 Jun 26;287(24):3215-22
references.pmid: 12076217
references.citation: N Engl J Med. 2005 Jul 21;353(3):238-48
references.pmid: 16034009
references.citation: Circulation. 2011 Nov 15;124(20):2233-42
references.pmid: 22007076
references.citation: Curr Med Res Opin. 2002;18(4):220-8
references.pmid: 12201623
references.citation: Stroke. 2013 Feb;44(2):448-56
references.pmid: 23287777
references.citation: N Engl J Med. 2005 Apr 7;352(14):1425-35
references.pmid: 15755765
references.citation: Stroke. 2013 Jul;44(7):1833-9
references.pmid: 23704101
references.citation: Lancet. 2004 Mar 6;363(9411):757-67
references.pmid: 15016485
references.citation: N Engl J Med. 1998 Nov 5;339(19):1349-57
references.pmid: 9841303
references.citation: Stroke. 2012 Jun;43(6):1518-23
references.pmid: 22442172
references.citation: N Engl J Med. 2007 Nov 29;357(22):2248-61
references.pmid: 17984166
references.citation: Stroke. 2013 Nov;44(11):3013-7
references.pmid: 24008570
references.citation: J Am Coll Cardiol. 2014 Jul 1;63(25 Pt B):2889-934
references.pmid: 24239923
references.citation: Stroke. 2014 May;45(5):1492-4
references.pmid: 24713533
references.citation: N Engl J Med. 2010 Apr 29;362(17):1563-74
references.pmid: 20228404
references.citation: J Am Coll Cardiol. 2014 Jul 1;63(25 Pt B):2960-84
references.pmid: 24239922
references.citation: Neurology. 2015 Feb 3;84(5):472-9
references.pmid: 25568296
references.citation: Lancet. 2012 Aug 11;380(9841):565-71
references.pmid: 22883507
references.citation: Neurology. 2007 Aug 28;69(9):904-10
references.pmid: 17724294
references.citation: Am J Cardiol. 2006 Apr 17;97(8A):77C-81C
references.pmid: 16581333
references.citation: Lancet. 2010 Feb 27;375(9716):735-42
references.pmid: 20167359
references.citation: BMJ. 2014 Jul 18;349:g4379
references.pmid: 25038074
references.citation: Stroke. 2009 Feb;40(2):382-8
references.pmid: 19095987
references.citation: Neurology. 2008 Jun 10;70(24 Pt 2):2364-70
references.pmid: 18077795
references.citation: BMJ. 1994 Jul 2;309(6946):11-5
references.pmid: 8044059
references.citation: Lancet. 2002 Jul 6;360(9326):7-22
references.pmid: 12114036
references.citation: J Clin Lipidol. 2014 May-Jun;8(3 Suppl):S58-71
references.pmid: 24793443
references.citation: J Am Coll Cardiol. 2005 Nov 15;46(10):1855-62
references.pmid: 16286171
references.citation: J Am Coll Cardiol. 2004 Nov 2;44(9):1772-9
references.pmid: 15519006
references.citation: BMJ Open. 2015 Feb 25;5(2):e007075
references.pmid: 25716175
references.citation: JAMA Neurol. 2014 Nov;71(11):1364-71
references.pmid: 25244578
references.citation: JAMA. 2005 Nov 16;294(19):2437-45
references.pmid: 16287954
references.citation: Atherosclerosis. 2012 Jul;223(1):1-68
references.pmid: 22698795
references.citation: Am J Cardiol. 2006 Apr 15;97(8):1165-71
references.pmid: 16616020
references.citation: N Engl J Med. 2014 Jul 17;371(3):203-12
references.pmid: 25014686
references.citation: J Am Coll Cardiol. 2012 Feb 7;59(6):572-82
references.pmid: 22300691
references.citation: N Engl J Med. 1989 Apr 6;320(14):904-10
references.pmid: 2619783
references.citation: N Engl J Med. 2004 Apr 8;350(15):1495-504
references.pmid: 15007110
references.citation: Lancet. 2012 Aug 11;380(9841):581-90
references.pmid: 22607822
references.citation: Stroke. 2012 Oct;43(10):2677-81
references.pmid: 22829545
references.citation: Acta Neurol Scand. 1992 Dec;86(6):572-8
references.pmid: 1481643
references.citation: J Am Coll Cardiol. 2014 Jul 1;63(25 Pt B):2935-59
references.pmid: 24239921
references.citation: Lancet. 1994 Nov 19;344(8934):1383-9
references.pmid: 7968073
references.citation: Lancet. 2005 Oct 8;366(9493):1267-78
references.pmid: 16214597
references.citation: N Engl J Med. 2009 Apr 2;360(14):1395-407
references.pmid: 19332456
references.citation: J Am Coll Cardiol. 2014 Jul 1;63(25 Pt B):2985-3023
references.pmid: 24239920
references.citation: N Engl J Med. 2008 Nov 20;359(21):2195-207
references.pmid: 18997196
references.citation: BMJ. 2009 Feb 16;338:b92
references.pmid: 19221140
references.citation: Neurology. 2013 May 7;80(19):1800-5
references.pmid: 23596066