Abstract Details

Title Cholesterol-Lowering Medication Use Prior to Ischemic Strokes Secondary to Large Artery Atherosclerosis or Small Vessel Disease: A Single Center Study

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S35 - Cerebrovascular Disease: Meta-analyses and Outcomes Research (2:36 PM-2:48 PM)

Poster/Presentation
Number 009

Background Dyslipidemia is a risk factor for ischemic stroke secondary to SVD and LAA. Studies have shown reduction in atherosclerotic cardiovascular disease (ASCVD) including ischemic stroke with cholesterol-lowering medications.

Objective Assess cholesterol-lowering medication usage before an acute ischemic stroke (AIS) due to either small vessel ischemic disease (SVD) or large artery atherosclerosis (LAA).

Design/Methods Consecutive patients with AIS admitted to a Comprehensive Stroke Center from 2015-2020 and either an SVD or LAA stroke etiology documented in the institutional stroke registry were included. Patients had a high ASCVD risk if they had a prior history of myocardial infarction, ischemic stroke, transient ischemic attack (TIA), or peripheral vascular disease (PVD), LDL > 160, or age 40 to 75 with diabetes mellitus, and were thus indicated for a cholesterol-lowering medication per 2018 AHA/ACC guidelines.

Results We included 647 patients, of whom 390 had LAA etiology and 257 had SVD etiology (median age 69 years [IQR 59-79], female 45.1%, NIHSS median 3 [IQR 1-8]). Comorbidities included hypertension (52.6%), dyslipidemia (78.2%), diabetes (37.2%), prior stroke (21.6%), prior TIA (5.7%), prior coronary artery disease or myocardial infarction (20.2%), and PVD (3.2%). A total of 337 (52.1%) of AIS patients were prescribed a cholesterol-lowering medication prior to stroke. Median LDL was 94 [IQR 71-123]. There were 133 (20.8%) high ASCVD risk patients not prescribed a cholesterol-lowering agent prior to stroke (17.4% of LAA and 25.3% of SVD AIS patients). Missed cholesterol-lowering prescription opportunities occurred mainly for the indications of diabetes (43.6%) and prior stroke (32.3%).

Conclusions Nearly 21% of AIS patients with stroke secondary to LAA or SVD were indicated for but did not previously take a cholesterol-lowering medication. Further studies are necessary to determine barriers to cholesterol-lowering therapy use to prevent ischemic stroke in patients who meet guideline criteria.

Authors/Disclosures
Anisha Garg, MD (Beth Israel Deaconness Medical Center) PRESENTER	Dr. Garg has nothing to disclose.
Anna Baker, PA (Center for Neurological Disorders SC)	No disclosure on file
	No disclosure on file
Adam De Havenon, MD, FAAN (Yale University)	Dr. De Havenon has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novo Nordisk. Dr. De Havenon has stock in Certus. Dr. De Havenon has stock in TitinKM. The institution of Dr. De Havenon has received research support from NIH/NINDS. Dr. De Havenon has received publishing royalties from a publication relating to health care.
Kevin N. Sheth, MD, FAAN (Yale UniversityDivision of Neuro and Critical Care)	Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. Dr. Sheth has received stock or an ownership interest from Astrocyte. Dr. Sheth has received stock or an ownership interest from Alva. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care.
Rachel Forman, MD (Yale Neurology)	Dr. Forman has nothing to disclose.
Richa Sharma, MD (Massachusetts General Hospital, Brigham, Harvard)	Dr. Sharma has received research support from NIH. Dr. Sharma has received intellectual property interests from a discovery or technology relating to health care.