Comments on ’When to Measure Lipid Profile after Stroke’

We congratulate Yan et al. [1] on an important study that provides new information regarding the evolution of lipid levels after stroke. However, we disagree with the management conclusions they draw based on their fi ndings. They advocate not initiating statins in patients with stroke and acutely normal cholesterol levels, citing the Heart Protection Study fi ndings that statins, while reducing coronary events, did not reduce stroke events in such patients. However, coronary events matter to patients and should matter to their stroke doctors. The benefi t of statins in reducing the incidence of major ischemic events in high vascular risk persons (including individuals with atherosclerotic stroke) with normal cholesterol levels has been established [2] . In addition, several studies show that early initiation of secondary preventive therapy is more effective than delayed initiation, with regard to patient adherence to long-term therapy, achievement of target national cholesterol guideline goals, and improved clinical outcomes [3] . The American Stroke Association has advised early statin initiation for patients with ischemic stroke of atherosclerotic origin [4] . The fi ndings of Yan et al. [1] indicate that, once in-hospital statin treatment in an atherosclerotic stroke patient has been initiated, lipid measurements at later timepoints should be obtained to guide further adjustment of lipid-lowering agents.