A Quantitative Study

Background:NewUSFoodandDrugAdministrationlabeling in 2003 recognizes stroke and evidence of cerebrovasculardiseaseasindicatorconditionsforinitiatingstatin (simvastatin) therapy, based on results of the Heart Protection Study, thereby extending the indications for statins in stroke beyond current US and European guidelines. Objective: To assess the impact on clinical practice of broadeningindicationsforstatinsinpatientswithstroke. Design: Observational study. Setting: University hospital stroke service. Patients: One hundred consecutive patients with ischemic stroke and transient ischemic attack. Interventions: Development and application of algorithmsforinitiatingstatintherapyinpatientswithstroke and transient ischemia abstracted from recent national and international guidelines (National Cholesterol EducationProgramAdultTreatmentPanelIII,EuropeanJoint TaskForceII),HeartProtectionStudyentrycriteria,and Heart Protection Study–based US Food and Drug Administration labeling. Main Outcome Measures:Percentages of patients who met clinical trial–validated and US Food and Drug Administration–approved criteria for initiation of statin therapy. Results: Patient age averaged 74 years (range, 35-96 years);64%werefemale,and74%werewhite.Strokesubtype was large-vessel atherosclerosis in 24%, cardioembolic in 44%, small-vessel atherosclerosis in 22%, and other in 10%. Twenty of 100 patients were already taking statins on admission. Guidelines for definite initiation of statin treatment were met by 48% of patients for theNationalCholesterolEducationProgramIII,38%for the European Joint Task Force II, 92% for the Heart Protection Study, and 100% for the Food and Drug Administration.

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