The beneficial effect of statins on ischemic stroke is most likely related to their capacity to reduce progression or to induce regression of atherosclerosis. Meta-analyses of statin trials found that statin therapy slows the progression of carotid IMT and that the magnitude of LDL cholesterol reduction correlates inversely with the progression of carotid IMT.153,163 Moreover, beneficial effects on carotid IMT are greater with higher-intensity statin therapy.164 166 In addition, plaque char- acteristics appear to improve with statin therapy. One study using high-resolution MRI reported that intensive lipid ther- apy depleted carotid plaque lipid,167 and another found that high-dose atorvastatin reduced carotid plaque inflammation as determined by ultrasmall superparamagnetic iron oxide Statins should be prescribed in accordance with the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. 169 These guidelines represent a dramatic shift away from specific LDL cholesterol targets. Instead, the guidelines call for esti- mating the 10-year risk for atherosclerotic CVD and, based on the estimated risk, prescribing a statin at low, moderate, or high intensity. The intensity of statin therapy depends on the drug and the dose. For example, lovastatin at 20 mg/d is con- sidered low-intensity therapy, and lovastatin at 40 mg/d is con- sidered moderate-intensity therapy. Atorvastatin at 10 mg/d is considered moderate-intensity therapy, and atorvastatin at 80 mg/d is considered high-intensity therapy. A cardiovascu- lar risk calculator to assist in estimating 10-year risk can be found online at http://my.americanheart.org/cvriskcalculator. Although the new guidelines shift focus away from specific lipid targets, values for total cholesterol and HDL are incor- porated into the cardiovascular risk calculator, along with age, sex, race, SBP, hypertension treatment, diabetes mellitus, and cigarette smoking. The benefits of lipid-modifying therapies other than statins on the risk of ischemic stroke are not established. 