Determination of Lipid Profile in Patients With Ischemic Stroke or Transient Ischemic Attack
To the Editor:
After reading the interesting article by Lalouschek et al,1 we think that the authors place too much trust in internists. As an alternative, we would like to report our data. In our hospital, Fatebenefratelli, in Milan, Italy, we admit all stroke patients in the General Medicine and Emergency Wards since we do not have a Neurology Department.
Since 1998 we have been registering every patient that has arrived in our hospital with an acute cerebrovascular accident. We retrospectively evaluated 1263 patients (628 men, 49.7%; mean age 76±13 years) with either an acute ischemic stroke (58.6%) or a transient ischemic attack (41.4%).
A knowledge of dyslipidemic disorder was present in only 91 patients (7.2%). Of these patients, 42 (46.2%) were treated with lipid-lowering drugs; specifically, 36 patients were treated with statins (14=simvastatin; 13=atorvastatin; 7=pravastatin; 1=fluvastatin; 1=cerivastatin) and 3 patients were treated with fibrates. In 3 patients the drug was not known.
A total of 905 of the 1263 patients have been admitted in General Medicine or the Emergency Department; we collected the laboratory data in 382 (42.2%) of these patients, and total cholesterol and triglyceride levels were measured in 57.9% and 55.0% of these patients, respectively. Total cholesterol determinations varied between the departments, ranging from 33.3% to 89.0%.
A total cholesterol level >200 mg/dL and a triglyceride level >150 mg/dL was present in 57.5% and 23.8% of patients, respectively.
Among 161 patients in whom the total cholesterol level was not determined, 81.4% presented relevant atherosclerosis risk factors such as chronic coronary disease, arterial hypertension, carotid stenosis, or previous ischemic cerebrovascular accidents.
Our data confirm that in general medical wards there still is not a deep knowledge of the role of lipid disorders in patients with acute ischemic stroke and transient ischemic attack. The lack of knowledge is probably the cause of the general low use of statins.
We confirm that educational programs are necessary to improve the knowledge of guidelines and recommendations currently not adequately followed.