Key result
Postoperative LDL-C ≥2.6 mmol/L significantly increased the risk of major adverse cardiovascular events (aHR 3.90) compared to LDL-C <1.8 mmol/L in patients following coronary artery bypass grafting.
Why the study?
The study evaluated the influence of low-density lipoprotein cholesterol and lipoprotein(a) on clinical outcomes in patients undergoing CABG.
Does exposure to increased levels of postoperative LDL-C or baseline Lp(a) increase the risk of mid-term major adverse cardiovascular events in patients following coronary artery bypass grafting?
Observational (n=459)
Open-label
Yes
Does exposure to increased levels of postoperative LDL-C or baseline Lp(a) increase the risk of mid-term major adverse cardiovascular events in patients following coronary artery bypass grafting?
Answers are grounded in this paper and cite their sources.
In patients undergoing coronary artery bypass grafting, elevated postoperative LDL-C (≥1.8 mmol/L) and baseline Lp(a) (≥30 mg/dL) are independently associated with an increased risk of mid-term major adverse cardiovascular events.
Purpose: The 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). Methods: This 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. Conclusions: For 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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Yu et al. (2023) conducted an observational in Coronary artery disease following coronary artery bypass grafting (CABG) (n=459). Postoperative LDL-C ≥2.6 mmol/L vs. Postoperative LDL-C <1.8 mmol/L was evaluated on 4-point major adverse cardiovascular events (MACE-4) (aHR 3.90, 95% CI 2.29-6.64, p=<0.001). Postoperative LDL-C ≥2.6 mmol/L significantly increased the risk of major adverse cardiovascular events (aHR 3.90) compared to LDL-C <1.8 mmol/L in patients following coronary artery bypass grafting.
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