Highlights
- •Post CABG, there was 14% reduction in all-cause mortality associated with more versus less intensive LDL-c reduction
- •There was 25% reduction in cardiovascular death in post CABG patients subjected to more intensive lipid-lowering treatment.
- •These mortality benefits were associated with both stable and acute coronary syndrome presentation following CABG.
Abstract
Background and aims
The recent reported analysis from the ODYSSEY OUTCOMES trial showed that patients
with previous coronary bypass graft surgery (CABG) had enhanced clinical benefits
in response to intensive low-density lipoprotein-cholesterol (LDL-c). Nonetheless,
the impact on cardiovascular and all-cause mortality was difficult to ascertain given
the relatively small number.
Methods
We conducted a meta-analysis investigating the role of more versus less intensive lipid-lowering treatment, taking into consideration the difference
in studies duration when reporting treatment effect.
Results
A significant 14% reduction in deaths from any cause [RR 0.86 (95% CI, 0.74 to 0.99)]
and 25% reduction in cardiovascular mortality [RR 0.75, (95% CI, 0.65 to 0.86)] were
associated with intensive LDL-c reduction in patients post CABG. Importantly, this
reduction was apparent in patients who were stable or developed an acute coronary
syndrome following CABG.
Conclusions
Patients with previous CABG incurred reduction in all-cause mortality and particularly
cardiovascular mortality in response to intensive LDL-c reduction. Patient's clinical
presentation following CABG did not modulate the associated benefits with intensive
LDL-c reduction. Characterising atherosclerotic disease may help identify other high-risk
groups who may benefit maximally from additional lipid-lowering therapies.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to AtherosclerosisAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- American Heart Association Council on Cardiovascular S, Anesthesia. Secondary prevention after coronary artery bypass graft surgery: a scientific statement from the American Heart Association.Circulation. 2015; 131: 927-964
- The benefit of adding ezetimibe to statin therapy in patients with prior coronary artery bypass graft surgery and acute coronary syndrome in the IMPROVE-IT trial.Eur. Heart J. 2016; 37: 3576-3584
- Investigators. Effects of alirocumab on cardiovascular events after coronary bypass surgery.J. Am. Coll. Cardiol. 2019; 74: 1177-1186
- Pravastatin prevents clinical events in revascularized patients with average cholesterol concentrations. Cholesterol and Recurrent Events CARE Investigators.J. Am. Coll. Cardiol. 1999; 34: 106-112
- Outcomes of patients with acute coronary syndrome and previous coronary artery bypass grafting (from the Pravastatin or Atorvastatin Evaluation and Infection Therapy [PROVE IT-TIMI 22] and the Aggrastat to Zocor [A to Z] trials).Am. J. Cardiol. 2008; 102: 552-558
- Long-term effects on clinical outcomes of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation in the post coronary artery bypass graft trial. Post CABG Investigators.Circulation. 2000; 102: 157-165
- Intensive lipid-lowering with atorvastatin for secondary prevention in patients after coronary artery bypass surgery.J. Am. Coll. Cardiol. 2008; 51: 1938-1943
- Plaque imaging to refine indications for emerging lipid-lowering drugs.Eur. Heart J. Cardiovasc. Pharmacother. 2017; 3: 58-67
- Mechanistic insights to target atherosclerosis residual risk.Curr. Probl. Cardiol. 2019; (Jun 24. pii: S0146-2806) ([Epub ahead of print]): 30105-30107https://doi.org/10.1016/j.cpcardiol.2019.06.004
- Pleiotropic effect of lovastatin, with and without cholestyramine, in the post coronary artery bypass graft (Post CABG) trial.Am. J. Cardiol. 2008; 102: 1023-1027
- PCI and CABG for treating stable coronary artery disease: JACC review topic of the week.J. Am. Coll. Cardiol. 2019; 73: 964-976
- Intensive versus moderate statin therapy and early graft occlusion after coronary bypass surgery: the Aggressive Cholesterol Therapy to Inhibit Vein Graft Events randomized clinical trial.J. Thorac. Cardiovasc. Surg. 2019; 157: 151-161 e1
- Interpretation of the evidence for the efficacy and safety of statin therapy.Lancet. 2016; 388: 2532-2561
- Alirocumab in patients with polyvascular disease and recent acute coronary syndrome: ODYSSEY OUTCOMES trial.J. Am. Coll. Cardiol. 2019; 74: 1167-1176
- Low-density lipoprotein cholesterol lowering with evolocumab and outcomes in patients with peripheral artery disease: insights from the FOURIER trial (further cardiovascular outcomes research with PCSK9 inhibition in subjects with elevated risk).Circulation. 2018; 137: 338-350
- Identification of patients and plaques vulnerable to future coronary events with near-infrared spectroscopy intravascular ultrasound imaging: a prospective, cohort study.Lancet. 2019; 394: 1629-1637
- Compliance with guideline-directed medical therapy in contemporary coronary revascularization trials.J. Am. Coll. Cardiol. 2018; 71: 591-602
Article Info
Publication History
Published online: December 13, 2019
Accepted:
December 12,
2019
Received in revised form:
December 4,
2019
Received:
November 7,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
