Long-Term Efficacy of Pravastatin Therapy in Diabetic Patients Undergoing Complete Coronary Revascularization

Aihara, Kouichiro; Miyauchi, Katsumi; Kasai, Takatoshi; Kubota, Naozumi; Kajimoto, Kan; Tamura, Hiroshi; Kojima, Takahiro; Yokoyama, Ken; Kurata, Takeshi; Amano, Atsushi; Daida, Hiroyuki

doi:10.5551/jat.1925

Cited by 11 publications

(4 citation statements)

References 17 publications

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“…78 Nearly identical findings were reported in 2 observational studies that followed, with significant associations demonstrated between postoperative statin therapy and lower all-cause mortality and cardiac events long term after CABG. 90,91 Of interest, the survival benefits associated with statins after CABG appear to be similar in magnitude to that associated with the use of 2 internal mammary artery grafts compared with the use of only 1 graft. 92 In addition to their lipid-lowering effects, statins appear have important non-lipid-related actions that may contribute to their beneficial effect.…”

Section: Antithrombotic Therapymentioning

confidence: 99%

Secondary Prevention After Coronary Artery Bypass Graft Surgery

Kulik¹,

Ruel²,

Jneid³

et al. 2015

Circulation

333

185

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Section: Antithrombotic Therapymentioning

confidence: 99%

Secondary Prevention After Coronary Artery Bypass Graft Surgery

Kulik¹,

Ruel²,

Jneid³

et al. 2015

Circulation

333

185

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“…Results from several observational studies proved that statin use was associated with improved survival and reduced MACE occurrence after CABG (37,38). In the present analysis, we focused on exploring the influence of statin adherence and found that poor adherence during the first year was correlated with increased risk of MACE, which suggested that CABG patients could benefit from long-term continuous statin use.…”

Section: Discussionmentioning

confidence: 99%

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

Xue

Líu

et al. 2023

Front. Cardiovasc. Med.

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PurposeThe objective was to evaluate the influence of low-density lipoprotein cholesterol (LDL-C) and lipoprotein(a) [Lp(a)] on clinical outcomes in patients undergoing coronary artery bypass grafting (CABG).MethodsThis is a secondary analysis of a 5-year follow-up of the DACAB trial (NCT02201771), in which 500 patients who underwent primary isolated CABG were randomized to three-antiplatelet therapy for 1 year after surgery. Of them, 459 patients were recruited in this secondary analysis. Baseline LDL-C and Lp(a) levels were collected, and repeated measurement of LDL-C levels during the follow-up were recorded. Cut-off values for LDL-C were set at 1.8 and 2.6 mmol/L; thus, the patients were stratified into LDL-C <1.8, 1.8–<2.6, and ≥2.6 mmol/L subgroups. Cut-off value for Lp(a) was 30 mg/dL; thus, the patients were divided into Lp(a) <30 and ≥30 mg/dL subgroups. The primary outcome was 4-point major adverse cardiovascular events (MACE-4), a composite of all-cause death, myocardial infarction, stroke, and repeated revascularization. Median follow-up time was 5.2 (interquartile range, 4.2–6.1) years.ResultsDuring the follow-up, 129 (28.1%) patients achieved the attainment of LDL-C <1.8 mmol/L, 186 (40.5%) achieved LDL-C 1.8–<2.6 mmol/L, and 144 (31.4%) remained LDL-C ≥2.6 mmol/L. Compared with the postoperative LDL-C <1.8 mmol/L group, the risk of MACE-4 was significantly higher in the LDL-C 1.8–<2.6 mmol/L group [adjusted hazard ratio (aHR) = 1.92, 95% CI, 1.12–3.29; P = 0.019] and LDL-C ≥2.6 mmol/L group (aHR = 3.90, 95% CI, 2.29–6.64; P < 0.001). Baseline Lp(a) ≥30 mg/dL was identified in 131 (28.5%) patients and was associated with an increased risk of MACE-4 (aHR = 1.52, 95% CI, 1.06–2.18; P = 0.022).ConclusionsFor CABG patients, exposure to increased levels of postoperative LDL-C or baseline Lp(a) was associated with worse mid-term clinical outcomes. Our findings suggested the necessity of achieving LDL-C target and potential benefit of adding Lp(a) targeted lipid-lowering therapy in CABG population.

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“…[3][4][5][6] Observational studies have shown that statin use is independently associated with a reduction in all-cause mortality and major adverse cardiovascular events (MACE) after CABG. [7][8][9] However, most of these studies were published decades ago, are limited to singlecenter investigations, or have limited information on medication adherence over time. More recently, in a study based, in part, on the same cohort as the present study, our group reported that ongoing treatment with statins was associated with better long-term survival.…”

Section: Perspectivementioning

confidence: 99%

“…CABG patients, the use of statins has consistently been associated with improved survival and a reduction of MACE in observational studies. 7,9,23 Accordingly, in all guidelines, statins are recommended as a secondary preventive medication for all CABG patients without contraindications. 2,6 However, the use of statins after CABG varies considerably in most observational, real-world studies.…”

Section: Adultmentioning

confidence: 99%

Statins for secondary prevention and major adverse events after coronary artery bypass grafting

Pan

Nielsen

Mennander

et al. 2022

The Journal of Thoracic and Cardiovascular Surgery

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Objective: The objective of this study was to evaluate the association of statin use after coronary artery bypass grafting (CABG) and long-term adverse events in a large population-based, nationwide cohort.Methods: All 35,193 patients who underwent first-time isolated CABG in Sweden from 2006 to 2017 and survived at least 6 months after surgery were included. Individual patient data from the Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) and 4 other nationwide registries were merged. Multivariable Cox regression models adjusted for age, sex, comorbidities, and time-updated treatment with other secondary preventive medications were used to evaluate the associations between statin treatment and outcomes. The primary end point was major adverse cardiovascular events (MACE). Median follow-up time to MACE was 5.3 (interquartile range, 2.5-8.2) years.Results: Statins were dispensed to 95.7% of the patients six months after discharge and to 78.9% after 10 years. At baseline, 1.4% of patients were prescribed low-, 57.6% intermediate-, and 36.7% high-dose statins. Ongoing statin treatment was associated with markedly reduced risk of MACE (adjusted hazard ratio [aHR], 0.

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Long-Term Efficacy of Pravastatin Therapy in Diabetic Patients Undergoing Complete Coronary Revascularization

Cited by 11 publications

References 17 publications

Secondary Prevention After Coronary Artery Bypass Graft Surgery

Secondary Prevention After Coronary Artery Bypass Graft Surgery

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

Statins for secondary prevention and major adverse events after coronary artery bypass grafting

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