In an interview, Dr. Flint said, “The results of the Intensive Cholesterol Level Lowering for Stroke Prevention trial have led to near unanimity in the stroke community that patients with a history of ischemic stroke should receive high-dose statin therapy to prevent stroke recurrence. Our question in this study was not whether treatment should be administered, but how to choose the timing of dosing.” The study included 12,689 patients with ischemic stroke treated at Kaiser Permanente Northern California between 2000 and 2007. 3,749 patients had been treated with statins for at least 3 months prior to stroke onset and were taking them regularly at admission, with the majority (3,280 or 87%) continuing statin therapy during hospitalization; 8, The majority of these patients (3,280 or 87%) continued statin therapy during hospitalization; 8,940 patients had no or intermittent statin therapy prior to stroke onset, and 3,013 (34%) of these patients were started on statins at the time of hospitalization. The study data revealed a 15% absolute reduction in mortality in the first year after stroke among early hospitalized users compared with those who were not treated with statins early in the hospitalization and before the stroke onset. After correcting for potential confounders such as age, sex, race, stroke duration, and comorbidities (e.g., hypertension and diabetes), the investigators found a statistically significant 45% relative reduction in the risk of death in the subsequent 1 year for users at the time of hospitalization compared with stroke patients not treated with statins at the time of hospitalization. A 15% relative reduction in 1-year mortality was also significant among patients who used a statin before the stroke episode but did not continue during hospitalization compared with those who were never treated with a statin. Dr. Flint said that treatment with statins during hospitalization appears to be a key factor in preventing death. In addition, there was a 41% relative reduction in mortality for users before stroke onset and at hospitalization compared with patients not treated with statins, and a 45% reduction for users only at hospitalization. Those who used statin therapy before stroke onset and discontinued it at the time of hospitalization had the worst prognosis, with a mortality rate 2.5 times higher than that of never users. Further analysis of the data highlights the importance of early initiation of statin therapy in hospitalized patients and also suggests a dose-effect relationship. Patients who took ≥60 mg of statins daily before or during hospitalization had significantly lower mortality relative to those taking <60 mg/day. Approximately 70% of patients in this study were taking lovastatin and approximately 20% were taking simvastatin. In terms of timing of dosing, patients who started or continued to use statins on day 1 of hospitalization had a significantly lower 1-year mortality rate than those who started users on day 3 of hospitalization. The investigators also conducted another analytical study to determine what was the cause and effect between patient survival prognosis and statin therapy. After examining the treatment patterns at the 17 Northern California Kaiser hospitals participating in the study, the investigators found that survival prognosis for those who used statins prior to hospitalization and discontinued them at hospitalization had some effect on this correlation but could not explain all of the effects on survival prognosis, suggesting that the use of statins during hospitalization itself had a significant effect on subsequent survival prognosis. Dr. Flint concluded that the strong effect of early initiation of statin therapy during stroke hospitalization on long-term survival is likely to be dependent on the pleiotropic nature of the statin rather than the effect of the statin on lipid levels.