Does lowering LDL improve CABG?
Does lowering LDL improve CABG?
The Post Coronary Artery Bypass Graft Trial Investigators. The effect of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation on obstructive changes in saphenous-vein coronary artery bypass grafts. N Engl J Med 1997; 336:153-162.
These investigators studied 1,351 patients who had undergone coronary artery bypass graft (CABG) surgery one to 11 years before baseline and who had a low-density lipoprotein (LDL) level of 130 to 175 mg per deciliter and at least one patent vein graft as seen on angiography. Patients received either an aggressive or moderate treatment to lower LDL cholesterol levels with lovastatin and chlestyramine. They were compared to patients receiving warfarin or placebo. Angiography was repeated an average of 4.3 years after baseline. The primary angiographic outcome was the mean percentage per patient of grafts with a decrease of 0.6 mm or more in lumen diameter.
The mean LDL cholesterol level of patients who received aggressive treatment ranged from 93 to 97 mg per deciliter. With moderate treatment, the range was from 132 to 136 mg per deciliter. The mean international normalized ratio was 1.4 in the warfarin group and 1.1 in the placebo group. The mean percentage of grafts with progression of atherosclerosis was 27% for patients whose LDL cholesterol level was lowered with aggressive treatment and 39% for patients who received moderate treatment.
There were no significant differences in angiographic outcome between the warfarin and placebo groups. The rate of revascularization over four years was 29% lower in the group whose LDL cholesterol level was lowered aggressively than in the group receiving moderate treatment (6.5% vs. 9.2% respectively).
"Aggressive lowering of LDL cholesterol levels to below 100 mg per deciliter reduced the progression of atherosclerosis in grafts," the researchers conclude. "Low-dose warfarin did not reduce the progression of atherosclerosis."
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