Table 2.

Recommendations for Lipid Management

Recommendations	Class, Level of Evidence
Class I Recommendations
Ischemic stroke or TIA patients with elevated cholesterol, comorbid coronary artery disease, or evidence of an atherosclerotic origin should be managed according to NCEP III guidelines, which include lifestyle modification, dietary guidelines, and medication recommendations.	Class I, Level A
Statin agents are recommended, and the target goal for cholesterol lowering for those with CHD or symptomatic atherosclerotic disease is an LDL-C level of <100 mg/dL. An LDL-C <70 mg/dL is recommended for very high-risk persons with multiple risk factors.	Class I, Level A
New Recommendation
On the basis of the SPARCL trial, administration of statin therapy with intensive lipid-lowering effects is recommended for patients with atherosclerotic ischemic stroke or TIA and without known CHD to reduce the risk of stroke and cardiovascular events.	Class I, Level B
Class II Recommendation
Ischemic stroke or TIA patients with low HDL cholesterol may be considered for treatment with niacin or gemfibrozil.	Class IIb, Level B

NCEP indicates National Cholesterol Education Panel; LDL-C, low-density lipoprotein cholesterol; and HDL, high-density lipoprotein.