The benefits of lipid-modifying therapies other than statins on the risk of ischemic stroke are not established. A meta- analysis of 78 lipid-lowering trials involving 266973 patients reported that statins decreased the risk of total stroke (OR, 0.85; 95% CI, 0.78 0.92), whereas the benefits of other lipid- lowering interventions were not significant, including diet Reduction in the risk of stroke is proportional to the reduction in total and LDL cholesterol; each 1% reduction in total cholesterol is associated with a 0.8% reduction in the risk of stroke. Similarly, another meta-analysis of 64 randomized, controlled trials reported that treatment-related decreases in LDL cholesterol were associated with decreases in all strokes 7.2); however, there was no relationship between triglycerides Niacin increases HDL cholesterol and decreases plasma levels of lipoprotein(a) [Lp(a)]. The Coronary Drug Project found that treatment with niacin reduced mortality in men with prior MI.171 In the Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health Outcomes (AIM-HIGH) study of patients with established CVD, the addition of extended-release niacin to intensive simvastatin therapy did not reduce the risk of a composite of cardiovascular Meschia et al Guidelines for the Primary Prevention of Stroke 3763 events, which included ischemic stroke.172 In a meta-analysis of 11 studies comprising 9959 subjects, niacin use was associated with a significant reduction in cardiovascular events, including a composite of cardiac death, nonfatal MI, hospitalization for acute coronary syndrome, stroke, or revascularization procedure (OR, 0.66; 95% CI, 0.49 0.89). There was an association between niacin therapy and coronary heart disease event (OR, 0.75; 95% CI, 0.59 0.96) but not with the incidence of stroke (OR, 0.88; However, there are serious safety concerns about niacin therapy. 