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

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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.

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Acknowledgments

A special thank you to Dr. John Brust for taking the time to review this article.

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Authors and Affiliations

  1. Department of Neurology, University of Iowa, Iowa City, IA, USA

    Sudeepta Dandapat

  2. 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

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Sudeepta Dandipat declares no conflict of interest.

Jennifer G. Robinson reports grants and personal fees from Akcea/Isis, Esperion Merck, Eli Lilly, Pfizer, Sanofi/Regeneron, and Amgen. Dr. Robinson also reports grants from Research grants to Institution: Amarin, Amgen, Astra-Zeneca, Eli Lilly, Esai, Glaxo-Smith Kline, Merck, Pfizer, Regeneron/Sanofi, Takeda.

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Dandapat, S., Robinson, J.G. Guidelines for Management of Hyperlipidemia: Implications for Treatment of Patients with Stroke Secondary to Atherosclerotic Disease. Curr Neurol Neurosci Rep 16, 24 (2016). https://doi.org/10.1007/s11910-016-0621-1

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