Treatment and Monitoring of Blood Lipids for Secondary Stroke Prevention Recommendations for Treating and Monitoring Hyperlipidemia Referenced studies that support recommendations are summarized in online Data Supplement 13. COR LOE Recommendations Treatment In patients with ischemic stroke with no known coronary heart disease, no major cardiac sources of embolism, and LDL cholesterol (LDL-C) >100 mg/dL, atorvastatin 80 mg daily is indicated to reduce risk of stroke recurrence.208,209 In patients with ischemic stroke or TIA and ath- erosclerotic disease (intracranial, carotid, aortic, or coronary), lipid-lowering therapy with a statin and also ezetimibe, if needed, to a goal LDL-C of <70 mg/dL is recommended to reduce the risk of major cardiovascular events.210 In patients with ischemic stroke who are very high risk (defined as stroke plus another major ASCVD or stroke plus multiple high-risk conditions), are taking maximally tolerated statin and ezetimibe therapy and still have an LDL-C >70 mg/dL, it is reasonable to treat with PCSK9 (proprotein convertase subtili- sin/kexin type 9) inhibitor therapy to prevent Monitoring In patients with stroke or TIA and hyperlip- idemia, patients adherence to changes in lifestyle and the effects of LDL-C lowering medication should be assessed by measure- ment of fasting lipids and appropriate safety indicators 4 to 12 weeks after statin initiation or dose adjustment and every 3 to 12 months thereafter, based on need to assess adher- ence or safety.214,215 Synopsis Two RCTs, SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels)208 and TST (Treat Stroke evaluated lipid-lowering therapy in patients after ischemic stroke. Both trials found significant benefit from cholesterol-lowering therapy in preventing vascular events, including stroke. SPARCL found that atorvastatin 80 mg daily reduced stroke recurrence in patients with- out another indication for statin therapy. 