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April 16, 2003

Reducing the Risk of Stroke

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(15):1927-1929. doi:10.1001/jama.289.15.1927

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.