Lipid Control Post Coronary Artery Bypass Graft: One Year Follow-Up of a Middle-Eastern Cohort

Abstract

Background: Data on patient characteristics and provider practices in the management of lipids per the new guidelines in specific secondary prevention patients in the Middle East is limited. Objective: To explore patient characteristics and lipid management practices according to the new cholesterol guidelines in secondary prevention patients, up to one year following discharge for coronary artery bypass graft surgery (CABG). Methods: A retrospective chart review of patients discharged post CABG between February 2017 and February 2018 at a quaternary care centre in the Middle East. Patients were characterized by baseline demographics, comorbidities, and use of lipid lowering medications. Results: 189 patients were included in the analysis. Most were diabetic (70.9%) and classified as very high risk per the ACC/AHA guidelines (84.1%) and as extremely high risk per the AACE guidelines (85.2%). Most patients (93.1%) were discharged on high intensity statin. About one third (28.6%) were never seen or only followed once within the first 2 weeks post discharge. Of those who continued to follow up beyond 3 months and within 1 year of discharge (44.4%), about half (51.2%) had follow-up lipid panels performed. Patients who followed up and were seen by a cardiologist were five times more likely to have lipid panels ordered than those seen solely by a CT surgeon. Of those with follow-up lipid panels beyond 3 months: 59.3% achieved LDL goal of <70 mg/dL and 29% achieved LDL <55 mg/dL based on their respective goals. Conclusions: Most patients undergoing CABG in a quaternary care centre in the Middle East are high risk ASCVD. Nonetheless, lipid goals are not commonly achieved nor routinely monitored. Providers will need to transition from the previous risk stratification and statin-only focused approach to adopt the most recent guidelines.

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

“…Our data provide important support to the relatively few real-world studies that have investigated whether patients undergoing CABG surgery attain lipid targets. 10 11 Similar to our study, a recent study from Israel found that only 44% of CABG surgery patients attained LDL-C levels <1.8 mmol/L (70 mg/dL) at follow-up. 10 In that study, a lack of attainment of lipid targets was independently associated with decreased survival; however, we did not find a significant association between the attainment of LDL-C targets and all-cause mortality in our study.…”

“… 10 Another study from the Middle East found that only 29% and 59.3% of CABG surgery patients attained LDL-C targets of <1.4 mmol/L (54 mg/dL) and <1.8 mmol/L (70 mg/dL) respectively. 11 Data from large registry studies in primary and secondary prevention cohorts in Europe have also shown that the ESC/EAS 2016 and 2019 guideline targets were attained in fewer than half and one-fifth of patients prescribed statin therapy, respectively. 19 Thus, despite the relative paucity of publications, it is evident that there remains an important gap in secondary prevention of CVD for CABG surgery patients.…”

“…However, few studies in the modern era have evaluated lipid management and attainment of lipid targets in patients who have undergone CABG surgery. 10 11 In light of updated guideline recommendations, the aim of this study was to determine the proportion of patients undergoing CABG surgery at an Australian hospital who had LDL-C levels above the threshold for adding non-statin lipid-lowering therapy and the proportion of patients who attained guideline-recommended LDL-C (primary) and non-HDL-C (secondary) targets. We sought to study the subset of patients with lipid profiles available electronically through the local pathology laboratory (PathWest Laboratory Medicine) system to ensure accuracy of both lipid results and the dates when they were obtained.…”

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

“…Likewise, under-implementation of the guideline recommended LDL-C target in the CABG population is common. 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).…”

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

“… 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.…”