Based on recent guidelines, which medication is most appropriate for secondary prevention of ischemic stroke in a patient with an LDL cholesterol level of 130 mg/dL?

The most appropriate medication for secondary prevention of ischemic stroke in a patient with an LDL cholesterol level of 130 mg/dL is atorvastatin at a high dose of 80 mg daily. Statins are recommended for secondary prevention following an ischemic stroke or transient ischemic attack (TIA) because they significantly reduce the risk of future cardiovascular events, including stroke. These medications not only lower LDL cholesterol levels effectively but also exert pleiotropic effects that contribute to their cardioprotective properties.

The guidelines emphasize the importance of high-intensity statin therapy for patients with a history of vascular events, particularly when LDL levels are above recommended targets. In this scenario, where the LDL level is higher than the optimal range (ideally below 70 mg/dL for secondary prevention), atorvastatin at a high dose can aid in achieving better lipid control and may help to stabilize atherosclerotic plaques, reducing the risk of subsequent ischemic events.

Other options may play roles in the management of patients who have suffered ischemic stroke, but they do not align with the specific guideline recommendations for dyslipidemia management and secondary prevention in this context. Aspirin is often used for antiplatelet therapy, clopidogrel serves a similar purpose