Key result
Aggressive lowering of LDL cholesterol to </dL reduced a composite clinical end point by 24% over 7.5 years compared with moderate reduction in post-CABG patients.
Why the study?
Does aggressive lowering of LDL cholesterol and low-dose anticoagulation reduce cardiovascular events and mortality in patients who had CABG surgery?
RCT (n=1,351)
Yes
Does aggressive lowering of LDL cholesterol and low-dose anticoagulation reduce cardiovascular events and mortality in patients who had CABG surgery?
Aggressive LDL-C lowering to <100 mg/dL and low-dose anticoagulation provide long-term clinical benefits in reducing cardiovascular events and mortality in post-CABG patients.
Answers are grounded in this paper and cite their sources.
Aggressive LDL-C lowering was associated with fewer events post-CABG; leaves open whether benefits persist in contemporary practice or require RCT confirmation.
BACKGROUND: The Post Coronary Artery Bypass Graft Trial, designed to compare the effects of 2 lipid-lowering regimens and low-dose anticoagulation versus placebo on progression of atherosclerosis in saphenous vein grafts of patients who had had CABG surgery, demonstrated that aggressive lowering of LDL cholesterol (LDL-C) levels to <100 mg/dL compared with a moderate reduction to 132 to 136 mg/dL decreased the progression of atherosclerosis in grafts. Low-dose anticoagulation did not significantly affect progression. METHODS AND RESULTS: Approximately 3 years after the last trial visit, Clinical Center Coordinators contacted each patient by telephone to ascertain the occurrence of cardiovascular events and procedures. The National Death Index was used to ascertain vital status for patients who could not be contacted. Vital status was established for all but 3 of 1351 patients. Information on nonfatal events was available for 95% of surviving patients. A 30% reduction in revascularization procedures and 24% reduction in a composite clinical end point were observed in patients assigned to aggressive strategy compared with patients assigned to moderate strategy during 7.5 years of follow-up, P=0. 0006 and 0.001, respectively. Reductions of 35% in deaths and 31% in deaths or myocardial infarctions with low-dose anticoagulation compared with placebo were also observed, P=0.008 and 0.003, respectively. The apparent long-term benefit of low-dose warfarin remains unexplained.
No takes yet. Share an insight, caveat, or question.
Knatterud et al. (2000) conducted an RCT in Post Coronary Artery Bypass Graft (CABG) surgery (n=1,351). Aggressive lowering of LDL cholesterol vs. Moderate reduction to 132 to 136 mg/dL was evaluated on Composite clinical end point (24% reduction, p=0.001). Aggressive lowering of LDL cholesterol to </dL reduced a composite clinical end point by 24% over 7.5 years compared with moderate reduction in post-CABG patients.
Synapse has enriched 10 related papers. Consider them for comparative context: