- Do not use fibrates, ezetimibe, bile acid sequestrants, nicotinic acid or omega-3 fatty acids for
cholesterol-lowering after stroke if the patient is unable to tolerate a statin.
Do try alternative methods to improve the tolerability of a statin such as a reduced dose, alternateday
dosing or a lower-intensity statin
- People with ischaemic stroke or TIA should be offered advice on lifestyle factors that may modify lipid levels, including diet, physical activity, weight, alcohol and smoking.
- People with ischaemic stroke or TIA should be offered treatment with a statin drug unless contraindicated. Treatment should: begin with a high intensity statin such as atorvastatin 20-80mg daily; Be with an alternative statin at the maximum tolerated dose if a high intensity statin is unsuitable or not tolerated; aim for a greater than 40% reduction in non-HDL cholesterol. If this is not achieved within 3 months, the prescriber should discuss adherence and timing of dose and optimise dietary and lifestyle measures; consider increasing to a higher dose if this was not prescribed from the outset.
- People with ischaemic stroke or TIA should not be prescribed fibrates, bile acid sequestrants,
nicotinic acid or omega-3 fatty acid compounds for secondary vascular prevention. Ezetimibe should be used only in people who also have familial hypercholesterolaemia.
- People with primary intracerebral haemorrhage should avoid statin treatment unless it is required for other indications.