Following CABG surgery, only 24.4% and 47.7% of patients attained the LDL-C targets of <1.4 mmol/L and <1.8 mmol/L respectively, highlighting a significant gap in lipid management despite high statin use.
Cohort (n=484)
No
Do patients undergoing CABG surgery attain guideline-recommended lipid targets in real-world practice?
A significant proportion of patients post-CABG do not achieve contemporary guideline-recommended lipid targets despite high rates of high-intensity statin prescription, highlighting the need for increased use of non-statin lipid-lowering therapies.
Objective: Patients undergoing coronary artery bypass graft (CABG) surgery remain at high cardiovascular risk; however, few studies have evaluated lipid management and attainment of lipid targets in these patients. We investigated the proportion of CABG surgery patients who attained low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (HDL-C) targets. Methods: Data were retrospectively obtained from patients undergoing CABG surgery at an Australian tertiary hospital between February 2015 and August 2020. The most recent lipid profile was recorded (at least 3 weeks post-operatively). We studied patients with electronically available data to ensure accuracy. Target LDL-C was defined as <1.4 (54 mg/dL) and <1.8 mmol/L (70 mg/dL), and target non-HDL-C as <2.2 (85 mg/dL) and <2.6 mmol/L (100 mg/dL), as per the 2019 and 2016 European dyslipidaemia guidelines, respectively. Results: Follow-up lipid results were available for 484 patients (median post-operative follow-up, 483 days; interquartile range, 177.5-938.75 days). The mean age was 62.7±10.5 years and 387 (80.1%) were male. At discharge, 469 (96.9%) patients were prescribed statins, 425 (90.6%) high-intensity. Ezetimibe was prescribed for 62 (12.8%) patients and a proprotein convertase subtilisin-kexin type 9 inhibitor for 1. LDL-C levels <1.4 and <1.8 mmol/L were attained in 118 (24.4%) and 231 (47.7%) patients, respectively, and non-HDL-C levels <2.2 and <2.6 mmol/L in 140 (28.9%) and 237 (49.0%) patients, respectively. Conclusion: The use of non-statin lipid-lowering therapies was limited, and many CABG surgery patients did not attain lipid targets despite high-intensity statins. Further studies are required to optimise lipid management in this very high-risk population.
Lan et al. (Sat,) conducted a cohort in Coronary Artery Bypass Graft (CABG) surgery (n=484). Lipid-lowering therapies (statins, ezetimibe) was evaluated on Attainment of guideline-recommended LDL-C target <1.4 mmol/L. Following CABG surgery, only 24.4% and 47.7% of patients attained the LDL-C targets of <1.4 mmol/L and <1.8 mmol/L respectively, highlighting a significant gap in lipid management despite high statin use.