In addition to therapeutic lifestyle changes, treat- ment with an HMG coenzyme-A reductase inhibitor (statin) medication is recommended for the primary prevention of ischemic stroke in patients estimated to have a high 10-year risk for cardiovascular events as recommended in the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults 169 (Class I; Level of Evidence A). 2. Niacin may be considered for patients with low HDL cholesterol or elevated Lp(a), but its efficacy in pre- venting ischemic stroke in patients with these con- ditions is not established. Caution should be used with niacin because it increases the risk of myopathy (Class IIb; Level of Evidence B). 3. Fibric acid derivatives may be considered for patients with hypertriglyceridemia, but their efficacy in pre- venting ischemic stroke is not established (Class IIb; Level of Evidence C). 4. Treatment with nonstatin lipid-lowering therapies such as fibric acid derivatives, bile acid sequestrants, niacin, and ezetimibe may be considered in patients who cannot tolerate statins, but their efficacy in preventing stroke is not established (Class IIb; Level of Evidence C). Diet and Nutrition A large and diverse body of evidence has implicated several aspects of diet in the pathogenesis of high BP, the major modifi- able risk factor for ischemic stroke. A scientific statement from the AHA concluded that several aspects of diet lead to elevated Specifically, dietary risk factors that are causally related to elevated BP include excessive salt intake, low potassium intake, excessive weight, high alcohol consumption, and suboptimal dietary pattern. 