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Stroke and transient ischaemic attack - Management
What lipid modification treatment is recommended for someone who has had a stroke or TIA?

The following recommendations apply to most people. They do not apply to people with lipid disorders such as familial hypercholesterolaemia:

  • A statin should be started:
    • As soon as possible for people with a transient ischaemic attack (TIA).
    • 48 hours after the event for people with an acute stroke.
  • People with an acute stroke or TIA who are already receiving statins should continue their statin treatment.
  • Seek specialist advice before initiating a statin in people with a history of haemorrhagic stroke, particularly those with inadequately controlled hypertension.
  • Before starting treatment:
    • Consider whether treatment is appropriate, taking into account comorbidities and life expectancy.
    • Perform baseline blood tests (for more information, see the section on Tests before drug treatment in the CKS topic on Lipid modification - CVD prevention).
    • Investigate for (and if found, manage) any conditions, such as diabetes, that are suggested by the baseline tests.
    • If dyslipidaemia is present, investigate for, and manage, secondary causes.
  • Consider higher-intensity statin therapy if the total cholesterol level does not decrease to below 4 mmol/L or the low-density lipoprotein cholesterol level does not decrease to below 2 mmol/L.
  • Optimize, as far as possible, the management of comorbidities and implementation of lifestyle interventions.
  • For more information (including options when simvastatin is not suitable), see the CKS topic on Lipid modification - CVD prevention and the appropriate sections in the CKS topic on Diabetes type 2.

In depth

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