Effect of an Aggressive Lipid-Lowering Strategy on Progression of Atherosclerosis in the Left Main Coronary Artery From Patients in the Post Coronary Artery Bypass Graft Trial

Abstract

Background-The Post Coronary Artery Bypass Graft Trial, designed to compare the effects of two lipid-lowering regimens and low-dose anticoagulation versus placebo on progression of atherosclerosis in saphenous vein grafts of patients who had had CABG surgery, demonstrated that aggressive lowering of LDL cholesterol levels to a mean yearly cholesterol level from 93 to 97 mg/dL compared with a moderate reduction to a level of 132 to 136 mg/dL decreased the progression of atherosclerosis in saphenous vein grafts. Low-dose anticoagulation did not affect progression. This secondary analysis tested the hypothesis that a similar decrease in progression of atherosclerosis would also be present in native coronary arteries as measured in the left main coronary artery (LMCA). Methods and Results-

Use of cardiovascular medical therapy among patients undergoing coronary artery bypass graft surgery: Results from the ROSETTA-CABG Registry

“…Past research has demonstrated the efficacy of acetylsalicylic acid and antilipid agents at reducing the risk of subsequent cardiovascular events among CAD patients with multiple comorbidities, including CABG surgery patients (8,(13)(14)(15). Thus, we expected to find fewer differences among patient subgroups.…”

“…Although many patients had comorbidities, suggesting that they would benefit from specific medical therapy, these subgroups were not always more likely to receive a specific medication than other patients. For example, the use of betablockers among patients with prior MI is well known to decrease mortality (15,16). However, patients with prior MI were found to be no more likely to receive beta-blockers than other patient subgroups at discharge and at 12 months following CABG surgery.…”

“…Very few studies have examined the benefits of cardiovascular medical therapy specifically among post-CABG surgery patients (7)(8)(9)(10). However, many factors that place a post-CABG surgery patient at increased risk for cardiac events are comorbidities for which targeted medical therapy already exists (11)(12)(13)(14)(15)(16)(17)(18)(19). In spite of this evidence, a number of researchers have documented a lack of optimal therapy among patients with a history of myocardial infarction (MI), congestive heart failure (CHF) or prior percutaneous coronary intervention (PCI) (20)(21)(22)(23)(24)(25).…”

Impact of Statin Use on Outcomes After Coronary Artery Bypass Graft Surgery

“…15,16 Similar findings were reported by the larger Post-CABG Trial that involved 1351 patients who had surgery 1 to 11 years previously. [7][8][9] Compared with patients randomized to lovastatin 5 mg/d, patients randomized to lovastatin 40 mg/d had a lower incidence of vein graft occlusive disease and less cardiovascular morbidity and mortality 4 years after randomization. [7][8][9] The 2 studies described above enrolled relatively healthy male patients under the age of 65 years who had undergone surgery several years earlier.…”

“…The Post-CABG Trial demonstrated that aggressive cholesterol treatment with lovastatin reduced the progression of vein graft disease and cardiovascular morbidity and mortality. [7][8][9] In contrast to the patients enrolled in the Post-CABG Trial, CABG patients in the current era are older, have more coexisting conditions, and are increasingly likely to be female. 10 Moreover, the Post-CABG Trial enrolled patients several years after they had undergone surgery (55% of patients had undergone surgery Ͼ5 years previously), with saphenous vein graft atherosclerosis likely already in progress.…”