Serum lipid profile on admission for ischemic stroke - Failure to meet national cholesterol education program adult treatment panel (NCEP-ATPIII) guidelines

被引:25
作者
Smith, Eric E.
Abdullah, Abdul R.
Amirfarzan, Houman
Schwamm, Lee H.
机构
[1] Massachusetts Gen Hosp, Stroke Serv, Boston, MA 02114 USA
[2] Massachusetts Gen Hosp, Dept Neurol, Boston, MA 02114 USA
关键词
D O I
10.1212/01.wnl.0000255941.03761.dc
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
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.
引用
收藏
页码:660 / 665
页数:6
相关论文
共 32 条
  • [11] Stroke prevention and atrial fibrillation: reasons leading to an inappropriate management. Main results of the SAFE II study
    Deplanque, D
    Leys, D
    Parnetti, L
    Schmidt, R
    Ferro, J
    De Reuck, J
    Mas, JL
    Gallai, V
    [J]. BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, 2004, 57 (06) : 798 - 806
  • [12] Goldstein LB, 2006, STROKE, V37, P1583, DOI 10.1161/01.STR.0000223048.70103.F1
  • [13] Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines
    Grundy, SM
    Cleeman, JI
    Merz, CNB
    Brewer, HB
    Clark, LT
    Hunninghake, DB
    Pasternak, RC
    Smith, SC
    Stone, NJ
    [J]. CIRCULATION, 2004, 110 (02) : 227 - 239
  • [14] SERUM-LIPID CHANGES FOLLOWING COMPLETED STROKE SYNDROME
    HOLLANDERS, FD
    BURTON, P
    SHAFAR, J
    [J]. POSTGRADUATE MEDICAL JOURNAL, 1975, 51 (596) : 386 - 389
  • [15] Johnston SC, 2005, NEUROLOGY, V65, P360
  • [16] CHOLESTEROL IN THE PREDICTION OF ATHEROSCLEROTIC DISEASE - NEW PERSPECTIVES BASED ON THE FRAMINGHAM STUDY
    KANNEL, WB
    CASTELLI, WP
    GORDON, T
    [J]. ANNALS OF INTERNAL MEDICINE, 1979, 90 (01) : 85 - 91
  • [17] Recent patterns of medication use in the ambulatory adult population of the United States - The Slone survey
    Kaufman, DW
    Kelly, JP
    Rosenberg, L
    Anderson, TE
    Mitchell, AA
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2002, 287 (03): : 337 - 344
  • [18] Determination of lipid profiles and use of statins in patients with ischemic stroke or transient ischemic attack
    Lalouschek, W
    Lang, W
    Greisenegger, S
    Müllner, M
    [J]. STROKE, 2003, 34 (01) : 105 - 110
  • [19] SERUM-LIPIDS AFTER STROKE
    MENDEZ, I
    HACHINSKI, V
    WOLFE, B
    [J]. NEUROLOGY, 1987, 37 (03) : 507 - 511
  • [20] Lipid testing and lipid-lowering therapy in hospitalized ischemic stroke and transient ischemic attack patients - Results from a statewide stroke registry
    Mullard, AJ
    Reeves, MJ
    Jacobs, BS
    Kothari, RU
    Birbeck, GL
    Maddox, K
    Stoeckle-Roberts, S
    Wehner, S
    [J]. STROKE, 2006, 37 (01) : 44 - 49