Attainment of Lipid Targets Following Coronary Artery Bypass Graft Surgery: Can We Do Better?

Abstract

Objective Patients undergoing coronary artery bypass graft (CABG) surgery remain at high cardiovascular risk; however, few studies have evaluated lipid management and attainment of lipid targets in these patients. We investigated the proportion of CABG surgery patients who attained low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (HDL-C) targets. Methods Data were retrospectively obtained from patients undergoing CABG surgery at an Australian tertiary hospital between February 2015 and August 2020. The most recent lipid profile was recorded (at least 3 weeks post-operatively). We studied patients with electronically available data to ensure accuracy. Target LDL-C was defined as <1.4 (54 mg/dL) and <1.8 mmol/L (70 mg/dL), and target non-HDL-C as <2.2 (85 mg/dL) and <2.6 mmol/L (100 mg/dL), as per the 2019 and 2016 European dyslipidaemia guidelines, respectively. Results Follow-up lipid results were available for 484 patients (median post-operative follow-up, 483 days; interquartile range, 177.5–938.75 days). The mean age was 62.7±10.5 years and 387 (80.1%) were male. At discharge, 469 (96.9%) patients were prescribed statins, 425 (90.6%) high-intensity. Ezetimibe was prescribed for 62 (12.8%) patients and a proprotein convertase subtilisin-kexin type 9 inhibitor for 1. LDL-C levels <1.4 and <1.8 mmol/L were attained in 118 (24.4%) and 231 (47.7%) patients, respectively, and non-HDL-C levels <2.2 and <2.6 mmol/L in 140 (28.9%) and 237 (49.0%) patients, respectively. Conclusion The use of non-statin lipid-lowering therapies was limited, and many CABG surgery patients did not attain lipid targets despite high-intensity statins. Further studies are required to optimise lipid management in this very high-risk population.

Intensive Lipid‐Lowering Therapy as per the Latest Dyslipidemia Management Guideline in Predicting Favorable Long‐Term Clinical Outcomes in Patients Undergoing Coronary Artery Bypass Grafting: A Retrospective Cohort Study

“…Similarly, in the International ChoLesterol management Practice study (ICLPS), a cross‐sectional observational study conducted in 18 countries, including the Gulf region, only 32.1% of the very high‐risk patients achieved their LDL‐C goal (1.80 mmol/L). 23 Moreover, in 2 single‐center observational studies, achievement of the LDL‐C treatment goal (1.40 mmol/L) in the extremely high‐risk patient group was noted in only 24.4% 14 and 29% 15 of those treated by lipid‐lowering agents. Furthermore, in a patient‐level pooled analysis of 3 randomized clinical trials undertaken by Farkouh et al, 22 including 4050 consecutive patients, the proportion of patients who had attained the LDL‐C goal (1.80 mmol/L) was only 35%.…”

“… 11 However, recent studies showed that a significant proportion of patients are undertreated and have LDL‐C levels exceeding the target, suggesting that the effect of LDL‐C on the prognosis of patients undergoing CABG was still disregarded or underestimated to some extent. 14 , 15 , 16 , 18 Generally, patients undergoing CABG have a more severe atherosclerotic disease, which may be the reason for their increased risk, but this also illustrates the greater benefits they experience in response to further LDL‐C reduction. Aggressive lipid‐lowering therapy is attractive to avoid post‐CABG saphenous vein graft disease and may be effective to maintain long‐term graft patency.…”

“… 2 However, a significant proportion of patients who have undergone CABG currently remain undertreated and have not attained guideline‐recommended levels of LDL‐C reduction. 14 , 15 , 16 It is important to investigate the lipid status of patients with MVD after CABG for clinicians to rationally adopt aggressive strategies to improve the prognosis of these patient populations. To date, there is a dearth of data on lipid status, lipid goal attainment after CABG, and the relationship between the attainment of lipid goals and long‐term outcomes.…”

Impact of low-density lipoprotein cholesterol and lipoprotein(a) on mid-term clinical outcomes following coronary artery bypass grafting: A secondary analysis of the DACAB trial

“…Results from 1-year follow-up of a Middle-Eastern cohort showed that 59.3% and 29% of CABG patients attained LDL-C targets of <1.8 mmol/L and 1.4 mmol/L, respectively (31). A most recent study from Australia with a median follow-up of 483 days reported that the attainment of LDL-C target <1.8 mmol/L was 47.7%and that of Frontiers in Cardiovascular Medicine 06 frontiersin.org <1.4 mmol/L was 24.4% (32). Another retrospective analysis of 1,230 CABG patients with a median follow-up period of 101 months showed that 44% of the patients reached the target of <1.8 mmol/L (33).…”