Aggressive LDL-C lowering (target 93-97 mg/dL) delayed progression of atherosclerosis in saphenous vein grafts across all subgroups, consistent with the 31% reduction seen in the main trial.
RCT
Does aggressive LDL-C lowering reduce the progression of saphenous vein graft atherosclerosis across different patient subgroups?
Aggressive LDL-C lowering consistently delays the progression of saphenous vein graft atherosclerosis regardless of age, gender, or the presence of other coronary heart disease risk factors.
BACKGROUND: The NHLBI Post Coronary Artery Bypass Graft trial (Post CABG) showed that aggressive compared with moderate lowering of low-density lipoprotein-cholesterol (LDL-C) decreased obstructive changes in saphenous vein grafts (SVGs) by 31%.1 Using lovastatin and cholestyramine when necessary, the annually determined mean LDL-C level ranged from 93 to 97 mg/dL in aggressively treated patients and from 132 to 136 mg/dL in the others (P/=200 mg/dL at baseline. As evidenced by similar odds ratio estimates of progression (lumen diameter decrease >/=0.6 mm) and lack of interactions with treatment, a similar beneficial effect of aggressive lowering was observed in elderly and young patients, in women and men, in patients with and without smoking, hypertension, or diabetes mellitus, and those with and without borderline high-risk triglyceride serum levels. The change in minimum lumen diameter was in the same direction for all subgroup categories, without significant interactions with treatment. CONCLUSIONS: Aggressive LDL-C lowering delays progression of atherosclerosis in SVGs irrespective of gender, age, and certain risk factors for CHD.
Campeau et al. (Tue,) conducted a rct in Post Coronary Artery Bypass Graft (CABG) with saphenous vein grafts. Aggressive LDL-C lowering (lovastatin and cholestyramine) vs. Moderate LDL-C lowering (target 132-136 mg/dL) was evaluated on Progression of atherosclerosis (lumen diameter decrease ≥0.6 mm). Aggressive LDL-C lowering (target 93-97 mg/dL) delayed progression of atherosclerosis in saphenous vein grafts across all subgroups, consistent with the 31% reduction seen in the main trial.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: