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Atherosclerosis. 2020 Jan;293:75-78. doi: 10.1016/j.atherosclerosis.2019.12.006. Epub 2019 Dec 13.

Effects of intensive lipid-lowering therapy on mortality after coronary bypass surgery: A meta-analysis of 7 randomised trials.

Author information

1
Cardiology Department, Royal Victoria Hospital, Belfast, UK; Cardiology Department, Toronto General Hospital, 200 Elizabeth Street, Toronto, M5G 2C4, Canada. Electronic address: mak-83@hotmail.com.

Abstract

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.

KEYWORDS:

CABG; PCSK9 inhibitors; Plaque imaging; Statin ezetimibe

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