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Serum lipid profile on admission for ischemic stroke

Failure to meet National Cholesterol Education Program Adult Treatment Panel (NCEP-ATPIII) guidelines

From the Department of Neurology and Stroke Service, Massachusetts General Hospital, Boston.

Address correspondence and reprint requests to Dr. Eric Smith, Assistant Professor of Neurology, Stroke Service, VBK 802, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114; e-mail: eesmith{at}partners.org

Objective: To determine the characteristics of patients with stroke/TIA whose admission low-density lipoprotein (LDL) levels were above goals defined by National Cholesterol Education Program Adult Treatment Panel (NCEP-ATPIII) guidelines.

Methods: From January 1, 2003, to June 30, 2005, there were 1,212 discharges (1,033 stroke, 179 TIA), of whom 1,040/1,212 (86%) had lipid measurement. The preadmission individual LDL goal was determined using 2001 NCEP-ATPIII guidelines.

Results: There were 284/1,040 (27%) whose measured LDL was greater than the individual preadmission LDL goal. Failure to be at goal was common even among those with previously diagnosed dyslipidemia (159/527, 30%) and those taking lipid-lowering agents (LLA) (71/370, 19%). LLA would have been indicated in 121/213 (57%) of those above LDL goal who were not already taking LLA, with optional consideration in 77/213 (36%). Lower LDL therapeutic targets were the strongest predictor, in a multivariable model, of failure to be at goal. Compared to LDL target <160 (reference), the OR for LDL target <130 was 6.4 (95% CI 3.4 to 12.0, p < 0.0001) and for LDL target <100 was 26.2 (95% CI 13.3 to 51.5, p < 0.0001). An increased likelihood of being at goal was associated with preadmission LLA (OR 4.2, 95% CI 2.9 to 6.2, p < 0.0001) and increasing calendar time (OR 1.09 per 3-month period, 95% CI 1.03 to 1.15, p = 0.004).

Conclusions: Many patients hospitalized with ischemic stroke/TIA, including those with known dyslipidemia and those taking lipid lowering agents, have measured low-density lipoprotein (LDL) that is higher than recommended by national guidelines. Patients at the greatest risk of cardiovascular events are the least likely to be at guideline-recommended LDL levels.

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 February 27 issue to find the title link for this article.

The study was not supported by external funding. Dr. Smith reports prior support from the National Institute of Neurological Disorders and Stroke (K23 NS46327) and Dr. Schwamm reports prior support from Astra Zeneca and BMS Sanofi.

Disclosure: The authors report no conflicts of interest.

Received June 21, 2006.

Accepted in final form November 7, 2006.

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