Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: Dr Straus and colleagues1 consider ischemic stroke a "coronary equivalent"
and thus recommended reducing low-density lipoprotein (LDL) cholesterol levels
to less than 100 mg/dL (2.59 mmol/L) in all patients with ischemic stroke.
The authors cited the National Cholesterol Education Program (NCEP) guidelines2 as supporting this position. However, the NCEP
guidelines define only stroke due to carotid artery disease as a coronary
risk equivalent. The NCEP guidelines do not provide recommendations on management
of LDL cholesterol in patients with ischemic stroke of other mechanisms, although
such treatment may be warranted on the basis of other risk factors and absolute
LDL levels. The implications of these positions are quite different.
Lakshminarayan K, Anderson DC. Reducing the Risk of Stroke. JAMA. 2003;289(15):1927-1929. doi:10.1001/jama.289.15.1927