MEDICAL DISCLAIMER:The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website.

Cholesterol Guidelines

Learning objectives

  • Learning
  • Understand
  • Integrate
  • Reflect

Link to RCP Stroke Guidelines 2016
  • 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.