Intensive lipid-lowering therapy reveals mortality benefits after CABG

  • Alkhalil M
  • Atherosclerosis
  • 13 Dec 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In patients with previous coronary artery bypass graft (CABG), intensive low-density lipoprotein-cholesterol (LDL-c) reduction was associated with a significant reduction in all-cause mortality and, particularly, cardiovascular (CV) mortality.
  • Patient’s clinical presentation after CABG did not alter the associated benefits with intensive LDL-c reduction.

Why this matters

  • Recent randomised controlled trials (RCTs) using ezetimibe from the IMPROVE-IT and alirocumab from the ODYSSEY-OUTCOMES trials showed improved clinical benefits and larger absolute risk reductions in patients with previous CABG.
  • Findings suggest characterising atherosclerotic disease may help identify high-risk individuals who may maximally benefit from additional lipid-lowering therapies.

Study design

  • Meta-analysis included 7 RCTs (n=10,420) after a search across Cochrane and MEDLINE databases.
  • Funding: None

Key results

  • More vs less intensive lipid-lowering therapy was associated with a significant reduction in all-cause (relative risk [RR], 0.86; 95% CI, 0.74-0.99; P=.04) and CV (RR, 0.75; 95% CI, 0.65-0.86; P<.0001 mortality in patients post-cabg.>
  • When the studies were stratified according to the clinical presentation after CABG, risk for all-cause and CV mortality reduced in patients who were stable (RR, 0.91; 95% CI, 0.74-1.13) and (RR, 0.71; 95% CI, 0.56-0.89) and developed an acute coronary syndrome (RR, 0.82; 95% CI, 0.65-1.03; Pinteraction=.49) and (RR, 0.76; 95% CI, 0.61-0.94; Pinteraction=.68).

Limitations

  • Heterogeneity among studies.