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Background and Purpose-Recent recommendations call for in-hospital initiation of lipid-lowering therapy (LLT) for most ischemic stroke (IS) and transient ischemic attack (TIA) survivors; however, little is known about actual use. This study describes use of and predictors for in-hospital lipid testing and LLT using data from a statewide stroke registry. Methods-In 2002, the registry ascertained cases from a stratified sample of 16 hospitals. This study includes only IS and TIA cases discharged alive. Results-In 1907 study subjects, 30.2% (27.2% to 33.5%) were on LLT at admission. In 1399 subjects not on LLT at admission, 37.2% (30.2% to 44.9%) underwent lipid testing, and 12.9% (7.2% to 22.1%) received LLT at discharge. Use of testing and LLT varied widely between hospitals (PϽ0.001). In-hospital lipid testing was positively associated with large teaching hospitals (Pϭ0.029), and neurologist or neurosurgeon (Pϭ0.004); and negatively associated with increasing age (Pϭ0.002), being female (Pϭ0.020), a previous medical history of atrial fibrillation (Pϭ0.002), nonambulatory status (Pϭ0.005), and poor prognosis (PϽ0.001). LLT at discharge was positively associated with a previous medical history of dyslipidemia (PϽ0.001), lipid testing (Pϭ0.004), and elevated low-density lipoprotein levels (PϽ0.001). Among subjects who were not on LLT at admission but who had Adult Treatment Panel III-based indications for use of LLT, only 31.2% (20.5% to 44.5%) received LLT at discharge. Conclusions-Many