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To the Editor: Dr Straus and colleagues¹ consider ischemic stroke a "coronary equivalent" and thus recommended reducing low-density lipoprotein (LDL) cholesterol levels to less than 100 mg/dL (2.59 mmol/L) in all patients with ischemic stroke. The authors cited the National Cholesterol Education Program (NCEP) guidelines² as supporting this position. However, the NCEP guidelines define only stroke due to carotid artery disease as a coronary risk equivalent. The NCEP guidelines do not provide recommendations on management of LDL cholesterol in patients with ischemic stroke of other mechanisms, although such treatment may be warranted on the basis of other risk factors and absolute LDL levels. The implications of these positions are quite different.

Furthermore, neither the guidelines of Straus et al nor those of the NCEP are based on actual trial results.

Kamakshi Lakshminarayan, MD, PhD; David C. Anderson, MD
Department of Neurology
Hennepin County Medical Center and University of Minnesota
Minneapolis

1. Straus SE, Majumdar SR, McAlister FA. New evidence for stroke prevention: scientific review. JAMA. 2002;288:1388-1395. FREE FULL TEXT 2. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285:2486-2497. FREE FULL TEXT

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289:1928.

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