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Aggressive lipid lowering after bypass reduces atherosclerosis in native arteries

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WESTPORT, CT (Reuters Health) – The progression of atherosclerosis in native coronary arteries after coronary artery bypass graft surgery (CABG) is reduced significantly more with a strategy of aggressive lipid lowering than with moderate lipid lowering, according to a report in Circulation: Journal of the American Heart Association for November 27.

Dr. Genell L. Knatterud, from the Maryland Medical Research Institute in Baltimore, and colleagues studied patients who had participated in the Post Coronary Artery Bypass Graft Trial. The results of that trial had shown that aggressive lipid lowering to a mean yearly cholesterol level of 93 to 97 mg/L decreased atherosclerosis progression in saphenous vein grafts compared with moderate lipid lowering to between 132 and 136 mg/L.

The researchers performed a secondary analysis of 402 of the 1102 patients who had had baseline and followup evaluations of the left main coronary artery. They found that compared with patients assigned to moderate lipid lowering, those assigned to an aggressive strategy had significantly better results in terms of minimum lumen diameter (p = 0.0003), maximum percent stenosis (p = 0.001), presence of substantial progression (p = 0.008) and presence of vascular occlusion (p = 0.005).

Dr. Knatterud and colleagues conclude that "these findings support the National Cholesterol Education Program's recommendation that LDL cholesterol should be reduced to less than 100 mg/dL in patients who have coronary artery disease."

In an accompanying editorial, Dr. David D. Waters and Dr. Priscilla Y. Hsue from the University of California at San Francisco review data from a variety of lipid-lowering trials. They conclude that "the current guidelines accurately reflect the current evidence, but both 130 mg/dL and 100 mg/dL [as target LDL cholesterol levels] may turn out not to be lines etched in stone."

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