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Published on: March 27, 2018
Attainment of lipid goals and long-term mortality after coronary-artery bypass surgery
Barak Zafrir1,2, Walid Saliba2,3, Ronen Jaffe1,2
11 Department of Cardiology, Lady Davis Carmel Medical Center and Clalit Health Services, Haifa, Israel.
Insights
Attaining optimal lipid levels after coronary-artery bypass graft surgery (CABG) is crucial. Poor lipid control, including high low-density lipoprotein cholesterol (LDL-C), is linked to increased long-term mortality risk post-CABG.
Area of Science:
- Cardiovascular Surgery
- Lipid Metabolism
- Clinical Outcomes Research
Background:
- Limited data exists on lipid goal attainment post-coronary-artery bypass graft surgery (CABG).
- The impact of post-CABG lipid levels on adverse outcomes requires further investigation.
Purpose of the Study:
- To assess lipid goal attainment in patients after CABG.
- To determine the association between achieved plasma lipid levels and long-term mortality.
Main Methods:
- Retrospective analysis of 1230 patients who underwent CABG.
- Mortality was analyzed concerning post-operative lipid levels (LDL-C, HDL-C, triglycerides) and pre-operative improvements.
Main Results:
- Only 44% of patients achieved target LDL-C (<70 mg/dL).
- Higher LDL-C, lower HDL-C, and elevated triglycerides were independently associated with increased long-term mortality.
- Optimal levels of all lipid measures significantly reduced mortality risk (P < 0.0001).
Conclusions:
- Suboptimal lipid levels are common after CABG and significantly increase long-term mortality risk.
- Addressing plasma lipid profiles is vital as both a risk marker and a treatment target post-CABG.
Introduction:
There is paucity of data regarding lipid goal attainment after coronary-artery bypass graft surgery (CABG) and its impact on adverse outcomes. We aimed to investigate the attainment of lipid goals and the association between plasma lipid levels achieved after CABG and mortality.
Methods:
Retrospective analysis of 1230 patients undergoing CABG. Mortality was examined in relation to most-recent lipid levels attained, categorized by clinically-relevant thresholds, and according to the improvement from pre-operative levels.
Results:
Low-density lipoprotein cholesterol (LDL-C) < 70 mg/dL was attained by 44% of the patients. After multivariable adjustment, the hazard ratio for long-term mortality was 1.33 (95% confidence interval, 1.05-1.67) and 1.97 (1.55-2.50) for patients attaining LDL-C 70-100 mg/dL and >100 mg/dL, respectively, compared with LDL-C < 70 mg/dL. The hazard ratio was 1.42 (1.07-1.88) and 1.73 (1.33-2.23) for patients attaining high-density lipoprotein cholesterol (HDL-C) 40-50 mg/dL and <40 mg/dL, respectively, compared with HDL-C > 50 mg/dL; and 1.11 (0.85-1.45) and 4.28 (1.89-9.68) for patients with triglycerides 200-500 mg/dL and >500 mg/dL compared with triglycerides <200 mg/dL. A progressive stepwise association was seen between the cumulative status of the lipid measures achieved and long-term mortality, with the lowest risk observed in those with optimal level of all lipid measures ( p < 0.0001). Improvement in any of the lipid measures from pre-operative to latest documented levels was associated with reduced mortality.
Conclusions:
Lack of attainment of optimal levels of routine lipid measures after CABG was common and associated both independently and additively with long-term mortality, emphasizing the importance of addressing plasma lipid profile as both a risk marker and a treatment target after CABG.
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