What is the clinical evidence from this study?

Study design: Cohort. Population: Coronary Artery Bypass Graft (CABG) surgery (n=484). Intervention: Lipid-lowering therapies (statins, ezetimibe). Primary outcome: Attainment of guideline-recommended LDL-C target <1.4 mmol/L.

January 1, 2022Open Access

Attainment of Lipid Targets Following Coronary Artery Bypass Graft Surgery: Can We Do Better?

Q: What are the key findings of this study?

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.

Key Result

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.

Study Design

Type

Cohort (n=484)

Multicenter

Structured PICO

Do patients undergoing CABG surgery attain guideline-recommended lipid targets in real-world practice?

Population

484 patients undergoing coronary artery bypass graft (CABG) surgery at an Australian tertiary hospital with follow-up lipid results, mean age 62.7 years, 80.0% male.

Intervention

Lipid-lowering therapy prescribed at discharge (predominantly high-intensity statins, with limited use of ezetimibe and PCSK9 inhibitors).

Outcome

Proportion of patients attaining target LDL-C (<1.4 and <1.8 mmol/L) and non-HDL-C (<2.2 and <2.6 mmol/L) levels at follow-up (median 483 days).surrogate

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.

Limitations

Retrospective and single-centre design
Lipid profile results extracted from a single laboratory database, potentially missing tests done elsewhere
Incomplete data on medication adherence, intolerance, or changes to lipid-lowering medications at follow-up
Apolipoprotein B levels were not routinely measured or studied
Limited length of follow-up and sample size for assessing mortality outcomes

Abstract

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.

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