1. Intensive Statin Recommendations

2. Intensive Statin Therapy Secondary Prevention Stroke
2008 AHA/ASA Recommendations: Class I recommendation: "On the basis of the SPARCL trial, administration of statin therapy with intensive lipid- lowering effects is recommended for patients with atherosclerotic ischemic stroke or TIA and without known CHD to reduce the risk of stroke and cardiovascular events.“
The following statins and total daily dose meet this criteria on the basis of published studies:
Atorvastatin (Lipitor) 40 mg or 80 mg total daily dose
Rosuvastatin (Crestor) 20 mg or 40 mg total daily dose
Simvastatin (Zocor or generic) 80 mg total daily dose*
Simvastatin/Ezetimibe (Vytorin) 10/80 mg dose*
*According to the June 8, 2011 FDA safety announcement physicians should limit using the simvastatin 80-mg dose unless the patient has already been taking the drug for 12 months and there is no evidence of myopathy htm
Reasons for not prescribing intensive statin therapy at discharge must be documented by a physician, PA, or APN.
Allergy to or complication related to statin therapy (history or current)
Patient/Family refused including patient preference for a less expensive, comparable alternative drug due to economic concerns (inability to pay).
Serious side effect to medication
Terminal illness/Comfort Measures Only
ICH within prior 6 months
Presently is achieving target LDL or LDL<100 spontaneously or by medical therapy,
Has no evidence of atherosclerosis
Has both CHD and ischemic stroke but there is documentation in the record as to why intensive statin therapy or an LDL goal of < 70mg/dL is not indicated
Has presence of hypertriglyceridemia (high triglycerides) that warrants treatment with an alternative lipid lowering agent such as a fibrate.