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Intensive lipid-lowering with atorvastatin for secondary prevention in patients after coronary artery bypass surgery

Sanjiv J Shah1, David D Waters, Philip Barter

  • 1Division of Cardiology, San Francisco General Hospital, University of California, San Francisco, California 94110, USA.

Journal of the American College of Cardiology
|May 17, 2008
PubMed

Insights

Intensive low-density lipoprotein (LDL)-cholesterol lowering with atorvastatin 80 mg/day significantly reduced major cardiovascular events by 27% in patients with prior coronary artery bypass grafting (CABG). This intensive treatment also decreased the need for repeat coronary revascularization by 30%.

Area of Science:

  • Cardiology
  • Vascular Biology
  • Pharmacology

Background:

  • Atherosclerosis progression is accelerated in coronary venous bypass grafts.
  • Patients with prior coronary artery bypass grafting (CABG) face increased cardiovascular risk.
  • Understanding optimal lipid-lowering strategies for these high-risk patients is crucial.

Purpose of the Study:

  • To evaluate the clinical benefit of intensive low-density lipoprotein (LDL)-cholesterol lowering in patients with previous CABG.
  • To assess the impact of atorvastatin 80 mg/day versus 10 mg/day on cardiovascular events in the CABG subgroup of the TNT trial.

Main Methods:

  • Post hoc analysis of 4,654 patients with prior CABG from the 10,001-patient TNT trial.
  • Randomization to atorvastatin 80 mg/day or 10 mg/day, with a median follow-up of 4.9 years.
  • Primary endpoint: first major cardiovascular event (cardiac death, myocardial infarction, resuscitated cardiac arrest, stroke).

Main Results:

  • Patients with prior CABG had a higher rate of major cardiovascular events (11.4%) compared to those without (8.5%).
  • Intensive LDL-lowering (mean 79 mg/dl) with atorvastatin 80 mg/day reduced primary events by 27% (HR 0.73, p=0.0004) in CABG patients.
  • Repeat revascularization was reduced by 30% (HR 0.70, p<0.0001) with intensive therapy.

Conclusions:

  • Intensive LDL-cholesterol lowering to a mean of 79 mg/dl with atorvastatin 80 mg/day provides significant clinical benefit for patients with prior CABG.
  • This strategy reduces major cardiovascular events and the need for repeat coronary revascularization.
  • Atorvastatin 80 mg/day is effective in managing cardiovascular risk in patients with previous CABG surgery.
Abstract

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