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From the Stroke Center and Department of Neurology (B.O., J.L.S.), UCLA School of Medicine, Los Angeles, CA; Division of Biostatistics and Epidemiology (H.B.), Weill Medical College of Cornell University, New York, NY; Department of Biostatistics (L.E.C.), School of Public Health, the University of North Carolina at Chapel Hill; Department of Neurology (A.N.), Washington University School of Medicine, St. Louis, MO; Department of Neurology (J.M.), McGill University, Montreal, Canada; and the Departments of Neurology (J.F.T.) and Medicine (Endocrinology/ Metabolism) (J.R.C.), Wake Forest University School of Medicine, Winston-Salem, NC.
Address correspondence and reprint requests to Dr. Bruce Ovbiagele, Stroke Center and Department of Neurology, University of California at Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095; e-mail: Ovibes{at}mednet.ucla.edu
Background: National cholesterol guidelines have defined high vascular risk individuals as those who could potentially benefit most from statin therapy. The authors aimed to determine the rate of statin use, its predictors, and the achievement of national guideline target lipid goals among ischemic stroke survivors.
Methods: The authors abstracted data from the Vitamin Intervention for Stroke Prevention (VISP) study database from the United States and Canada to incorporate into algorithms for initiating statin therapy according to the National Cholesterol Education Program (NCEP) guidelines for high-risk individuals. The authors applied these algorithms to all study subjects. Univariate as well as multivariate associations for target lipid levels and statin implementation were then evaluated utilizing pertinent demographic, clinical, and laboratory data.
Results: Of 2,894 subjects in the analysis dataset, 38% were women; 71% were recruited in the United States and 29% in Canada. Of 769 high-risk subjects, 262 (34%) had a low-density lipoprotein (LDL) level 
130 mg/dL and 124 of these (47%) were not on statin. Among those high-risk persons on statin treatment, only 42% had an LDL 
100 mg/dL. Subjects in the overall cohort were more likely to be on a statin if they were treated in the United States or had a history of hypertension or coronary artery disease.
Conclusions: Approximately one out of three guideline-eligible high vascular risk ischemic stroke patients in this study had low-density lipoprotein cholesterol concentrations above qualifying levels for pharmacologic therapy, but half of these patients were not taking a statin, and of those receiving statin treatment, less than half were within recommended lipid goals.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the April 25 issue to find the title link for this article.
Editorial, see page 1140
*The VISP Study Investigators are listed in the Appendix on the Neurology Web site at www.neurology.org.
Supported by the National Institute of Neurological Disorders and Stroke grant RO1 NS34447 (J.F.T.).
Disclosure: Bruce Oviagele has received consultancy fees from Bristol-Myers-Squibb. The authors report no conflicts of interest.
Received October 13, 2005. Accepted in final form January 13, 2006.
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Neurology 2006 66: 1136-1137.
Neurology 2006 66: 1140-1141.
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