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Quality of life after coronary artery bypass graft: results from the POST CABG Trial
Norma Lynn Fox1, Byron J Hoogwerf, Susan Czajkowski
1Maryland Medical Research Institute, Baltimore, MD, USA. normalynn_fox@HGSI.com
Insights
Aggressive low-density lipoprotein (LDL) cholesterol lowering therapy did not impact patient health-related quality of life (HRQL) after coronary artery bypass graft surgery. Anticoagulation therapy also showed no effect on HRQL.
Area of Science:
- Cardiovascular Medicine
- Health-Related Quality of Life Research
- Clinical Trial Analysis
Background:
- The POST CABG Trial demonstrated that aggressive low-density lipoprotein (LDL) cholesterol lowering reduces atherosclerosis progression and clinical events in saphenous vein grafts.
- Low-dose anticoagulation therapy did not show benefits in reducing atherosclerosis progression.
Purpose of the Study:
- To evaluate the impact of lipid-lowering and low-dose anticoagulation therapies on health-related quality of life (HRQL) in post-coronary artery bypass graft (CABG) patients.
- To analyze HRQL changes in patients receiving aggressive vs. moderate LDL cholesterol lowering and low-dose warfarin vs. placebo.
Main Methods:
- A randomized clinical trial with a factorial design involving 852 outpatients from five tertiary care centers.
- Patients completed HRQL questionnaires at baseline, 2 years, and 4 years, assessing emotional status, functioning, perceived health, pain, physical symptoms, and life satisfaction.
Main Results:
- No systematic differences in HRQL parameters were observed among treatment groups at baseline, year 2, or year 4.
- Neither aggressive LDL cholesterol lowering nor low-dose anticoagulation therapy demonstrated significant positive or negative effects on patient HRQL.
Conclusions:
- Aggressive LDL cholesterol-lowering therapy, despite its benefits in atherosclerosis treatment, did not alter patient HRQL.
- Low-dose anticoagulation therapy also showed no discernible impact on the health-related quality of life in this patient cohort.
Objectives:
The POST CABG (Post Coronary Artery Bypass Graft) Trial showed that aggressive lowering of low-density lipoprotein (LDL) cholesterol levels reduced the progression of atherosclerosis in saphenous vein grafts. In the extended follow-up phase, aggressive lowering of LDL cholesterol levels was associated with reduced rates of clinical events. Low-dose anticoagulation therapy did not reduce the progression of atherosclerosis. We conducted this analysis to determine the effects of both lipid-lowering and low-dose anticoagulation therapy on health-related quality of life (HRQL).
Design:
Randomized clinical trial, factorial design.
Setting:
Outpatients in five tertiary care medical centers.
Patients:
A cohort of 852 patients enrolled in the POST CABG Trial completed an HRQL questionnaire at baseline, and at the year 2 and year 4 follow-up visits.
Intervention:
Aggressive LDL cholesterol lowering vs moderate LDL cholesterol lowering, and low-dose warfarin vs placebo.
Measurements:
Domains included emotional status, basic physical and social functioning, perceived health status, symptoms of pain, a variety of physical symptoms, and global life satisfaction.
Results:
Overall, there were no indications of systematic differences among treatment groups for any of the HRQL parameters at baseline, year 2, or year 4.
Conclusions:
These data indicate that patients did not experience detrimental or beneficial effects on HRQL parameters while receiving LDL cholesterol-lowering therapy that had demonstrable benefits for treatment of atherosclerosis.
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