Published Online
on December 8, 2005

A more recent version of this article appeared on January 1, 2006

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Submitted on September 22, 2005
Accepted on October 13, 2005

Lipid Testing and Lipid-Lowering Therapy in Hospitalized Ischemic Stroke and Transient Ischemic Attack Patients. Results From a Statewide Stroke Registry

Andrew J. Mullard MS; Mathew J. Reeves PhD^*; Bradley S. Jacobs MD; Rashmi U. Kothari MD; Gretchen L. Birbeck MD; Kate Maddox MS; Stacey Stoeckle-Roberts MSN; Susan Wehner MSN; for the Paul Coverdell National Acute Stroke Registry Michigan Prototype Investigators

From the Department of Epidemiology (A.J.M., M.J.R., G.L.B., S.W.), Michigan State University, East Lansing, Mich; Department of Neurology (B.S.J.), Wayne State University School of Medicine, Detroit, Mich; Borgess Health System (R.U.K.), Kalamazoo, Mich; Department of Neurology and Ophthalmology (G.L.B., S.W.), Michigan State University, East Lansing, Mich; Department of Neurology (K.M.), University of Michigan, Ann Arbor, Mich; and Michigan Department of Community Health (S.S.-R.), Lansing, Mich.

^* To whom correspondence should be addressed. E-mail: reevesm{at}msu.edu.

Background and Purpose--Recent recommendations call for in-hospital initiation of lipid-lowering therapy (LLT) for most ischemic stroke (IS) and transient ischemic attack (TIA) survivors; however, little is known about actual use. This study describes use of and predictors for in-hospital lipid testing and LLT using data from a statewide stroke registry.

Methods--In 2002, the registry ascertained cases from a stratified sample of 16 hospitals. This study includes only IS and TIA cases discharged alive.

Results--In 1907 study subjects, 30.2% (27.2% to 33.5%) were on LLT at admission. In 1399 subjects not on LLT at admission, 37.2% (30.2% to 44.9%) underwent lipid testing, and 12.9% (7.2% to 22.1%) received LLT at discharge. Use of testing and LLT varied widely between hospitals (P<0.001). In-hospital lipid testing was positively associated with large teaching hospitals (P=0.029), and neurologist or neurosurgeon (P=0.004); and negatively associated with increasing age (P=0.002), being female (P=0.020), a previous medical history of atrial fibrillation (P=0.002), nonambulatory status (P=0.005), and poor prognosis (P<0.001). LLT at discharge was positively associated with a previous medical history of dyslipidemia (P<0.001), lipid testing (P=0.004), and elevated low-density lipoprotein levels (P<0.001). Among subjects who were not on LLT at admission but who had Adult Treatment Panel III-based indications for use of LLT, only 31.2% (20.5% to 44.5%) received LLT at discharge.

Conclusions--Many hospitalized acute IS and TIA patients with indications for LLT are untreated at discharge. Efforts to close treatment gaps in lipid evaluation and treatment require sustained quality improvement efforts and should pay particular attention to high-risk patients.

Key words: lipids • quality of health care • registries • stroke, acute

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