Do people with carotid plaque need to be treated with a statin? This is a question often asked by patients in clinical practice. This question cannot be generalized and should be considered in the context of the patient’s degree of carotid stenosis, the presence of cardiovascular disease or risk factors for cardiovascular disease, and the level of low-density lipoprotein cholesterol (LDL-C). In the management of atherosclerotic ischemic stroke/TIA, a ≥50% reduction in LDL-C or an LDL-C level <1.8 mmol/L is key to achieving optimal treatment goals. And most patients should also be considered for aspirin antiplatelet therapy. If carotid plaque has not led to significant stenosis (<50% stenosis), patients need to be evaluated for the presence of cardiovascular disease or other risk factors for cardiovascular disease. The following may be possible: 1. Patients with established coronary heart disease or ischemic stroke should receive immediate statin therapy to control LDL-C below 1.8 mmol/L regardless of significant stenosis in the carotid artery; 2. Patients with atherosclerotic-derived ischemic stroke/TIA without known coronary heart disease (CHD), the appropriate target for maximizing clinical benefit is an LDL-C reduction of ≥50% or 3. Patients with diabetes mellitus and LDL-C >2.6 mmol/L who require statin therapy; 4. Patients with hypertension or other risk factors and LDL-C >3.4 mmol/L for whom statin therapy is recommended to reduce LDL-C to <3.4 mmol/L. 5. For patients with ischemic stroke/TIA with an LDL-C level ≥2.6 mmol/L, the appropriate target value for optimal efficacy is an LDL-C reduction of ≥50% or an LDL-C level <1.8 mmol/L.