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Effects of intensive lipid-lowering therapy on mortality after coronary bypass surgery: A meta-analysis of 7
1Cardiology Department, Royal Victoria Hospital, Belfast, UK; Cardiology Department, Toronto General Hospital, 200 Elizabeth Street, Toronto, M5G 2C4, Canada.
Insights
Intensive low-density lipoprotein-cholesterol (LDL-c) reduction significantly lowered mortality in patients post coronary artery bypass graft (CABG) surgery. These benefits were observed regardless of clinical presentation, highlighting LDL-c management importance.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Clinical Trials
Background:
- Previous analyses suggested clinical benefits of intensive low-density lipoprotein-cholesterol (LDL-c) reduction in patients post coronary artery bypass graft (CABG) surgery.
- The impact on mortality in this specific patient group was previously unclear due to limited data.
Purpose of the Study:
- To conduct a meta-analysis on intensive versus less intensive lipid-lowering treatment in patients post-CABG.
- To evaluate the effect of lipid-lowering strategies on cardiovascular and all-cause mortality, considering study duration.
Main Methods:
- Meta-analysis of studies comparing intensive and less intensive lipid-lowering treatments.
- Inclusion of studies that accounted for treatment duration in their analysis.
Main Results:
- Intensive LDL-c reduction was associated with a significant 14% decrease in all-cause mortality (RR 0.86, 95% CI 0.74-0.99).
- A significant 25% reduction in cardiovascular mortality was observed (RR 0.75, 95% CI 0.65-0.86).
- These benefits were consistent in patients who were stable or experienced acute coronary syndrome post-CABG.
Conclusions:
- Patients with prior CABG benefit from intensive LDL-c reduction, experiencing decreased all-cause and cardiovascular mortality.
- Clinical presentation post-CABG did not alter the benefits of intensive LDL-c reduction.
- Further research into characterizing atherosclerotic disease may identify additional high-risk groups for intensified lipid-lowering therapies.
Background And Aims:
The recent reported analysis from the ODYSSEY OUTCOMES trial showed that patients with previous coronary bypass graft surgery (CABG) had enhanced clinical benefits in response to intensive low-density lipoprotein-cholesterol (LDL-c). Nonetheless, the impact on cardiovascular and all-cause mortality was difficult to ascertain given the relatively small number.
Methods:
We conducted a meta-analysis investigating the role of more versus less intensive lipid-lowering treatment, taking into consideration the difference in studies duration when reporting treatment effect.
Results:
A significant 14% reduction in deaths from any cause [RR 0.86 (95% CI, 0.74 to 0.99)] and 25% reduction in cardiovascular mortality [RR 0.75, (95% CI, 0.65 to 0.86)] were associated with intensive LDL-c reduction in patients post CABG. Importantly, this reduction was apparent in patients who were stable or developed an acute coronary syndrome following CABG.
Conclusions:
Patients with previous CABG incurred reduction in all-cause mortality and particularly cardiovascular mortality in response to intensive LDL-c reduction. Patient's clinical presentation following CABG did not modulate the associated benefits with intensive LDL-c reduction. Characterising atherosclerotic disease may help identify other high-risk groups who may benefit maximally from additional lipid-lowering therapies.
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