Lipid Testing and Lipid-Lowering Therapy in Hospitalized Ischemic Stroke and Transient Ischemic Attack Patients

Abstract

Background and Purpose— Recent recommendations call for in-hospital initiation of lipid-lowering therapy (LLT) for most ischemic stroke (IS) and transient ischemic attack (TIA) survivors; however, little is known about actual use. This study describes use of and predictors for in-hospital lipid testing and LLT using data from a statewide stroke registry. Methods— In 2002, the registry ascertained cases from a stratified sample of 16 hospitals. This study includes only IS and TIA cases discharged alive. Results— In 1907 study subjects, 30.2% (27.2% to 33.5%) were on LLT at admission. In 1399 subjects not on LLT at admission, 37.2% (30.2% to 44.9%) underwent lipid testing, and 12.9% (7.2% to 22.1%) received LLT at discharge. Use of testing and LLT varied widely between hospitals ( P <0.001). In-hospital lipid testing was positively associated with large teaching hospitals ( P =0.029), and neurologist or neurosurgeon ( P =0.004); and negatively associated with increasing age ( P =0.002), being female ( P =0.020), a previous medical history of atrial fibrillation ( P =0.002), nonambulatory status ( P =0.005), and poor prognosis ( P <0.001). LLT at discharge was positively associated with a previous medical history of dyslipidemia ( P <0.001), lipid testing ( P =0.004), and elevated low-density lipoprotein levels ( P <0.001). Among subjects who were not on LLT at admission but who had Adult Treatment Panel III–based indications for use of LLT, only 31.2% (20.5% to 44.5%) received LLT at discharge. Conclusions— Many hospitalized acute IS and TIA patients with indications for LLT are untreated at discharge. Efforts to close treatment gaps in lipid evaluation and treatment require sustained quality improvement efforts and should pay particular attention to high-risk patients.