Lipid assessment and treatment patterns in hospitalized TIA and ischemic stroke patients

BACKGROUND: Identification of dyslipidemia and treatment with lipid-lowering agents are established targets for quality performance during hospitalization for ischemic stroke and transient ischemic attack (TIA). We aimed to study the frequency and predictors of lipid assessment and discharge utilization of lipid-lowering therapies among patients hospitalized for stroke and TIA. METHODS: Demographics, clinical findings, and laboratory data were documented as part of the California Acute Stroke Prototype Registry (CASPR). Frequency of low-density lipoprotein cholesterol (LDL-C) testing and the frequency and appropriate use of lipid-lowering treatment according to national cholesterol guidelines were determined. Multivariate models were generated to determine the contribution of clinical variables to LDL testing and prescription of lipid-lowering medications at discharge. RESULTS: Data were collected on 764 consecutive patients with ischemic stroke or TIA treated at 11 hospitals over a 2-year period. LDL-C measurements were performed in only 50.1% during hospitalization. Measurement of LDL-C was most strongly and independently associated with diagnosis of ischemic stroke (vs. TIA, P = .02) and history of dyslipidemia (P = .05). Overall, 48.4% of the CASPR cohort received lipid-lowering medications at discharge. Independent predictors for being prescribed lipid-lowering agents at discharge were diagnosis of ischemic stroke (P = .0009), LDL-C testing (P = .0002), high risk of future coronary events according to national guidelines (P = .02), and history of dyslipidemia (P< .0001). Only 59% of patients at high risk for future coronary events were discharged on a lipid-lowering medication. CONCLUSIONS: Serum cholesterol testing and treatment are underutilized during hospitalization for ischemic stroke or TIA.