When to measure lipid profile after stroke?

Background: Although acute decreases in total cholesterol (TC) are well documented in myocardial infarction, previous stroke studies have produced conflicting results. The timing of lipid estimation in ischemic stroke is becoming important with recent trial results indicating the benefits of statins. We therefore aimed to determine the optimal time for lipid measurements after stroke. We hypothesized that TC would acutely decrease after stroke and return to baseline by 12 weeks.

Methods And Results: We performed a prospective, observational study of 50 patients (age 68.5 +/- 11.2 years) who presented with acute ischemic stroke. Of these, 22 (44%) were HMG-CoA reductase (statin) naïve, 15 (30%) had already been on statins and 13 (26%) were commenced on statins. Of the 50 patients, 38 (76%) completed 12 weeks of follow-up, 5 died, and 7 were lost to follow-up. Fasting lipid profile (TC, low-density lipoprotein, high-density lipoprotein, triglyceride) was measured <48 h, 4 weeks and 12 weeks following ictus. In patients who were statin naïve, there was a significant increase in TC at the week 12 evaluation.

Conclusions: Cholesterol levels in acute stroke are an unreliable measure of lipid status. Initiation of statins should ideally be based on measurements taken 12 weeks after stroke.