Attainment of lipid goals and long-term mortality after coronary-artery bypass surgery

Abstract

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.

Lipid Control Post Coronary Artery Bypass Graft: One Year Follow-Up of a Middle-Eastern Cohort

“…A more recent study looking at attainment of lipid goals post-CABG in an Israeli-cohort found that 44% (vs 58%) of their patients achieved LDL-C levels below 70 mg/dL, with only 43% (vs 72%) having diabetes. The mean age was also higher (65 ± 9 vs 59.7 ± 10.4), with 80% (vs 87.8%) of the patients being male [25]. Targets below 55 mg/dL have not been reported in the studies, owing to its more recent introduction in guidelines.…”

“…Lack of attainment of lipid target levels following CABG has been associated with long-term mortality [6]. Various guidelines, such as the 2017 European Academy of Cardio-Thoracic Surgery Guidelines on Perioperative Medication in Adult Cardiac Surgery [7], have been proposed by different international organizations, all of which provide practical guidance for healthcare professionals on the optimal management of ASCVD.…”

Focus on atherosclerosis and lipids

“…Dyslipidemia is an important cause of atherosclerotic cardiovascular disease (ASCVD) worldwide that leads to an increased risk of morbidity and mortality. 1 Treating dyslipidemia to goal reduces the risks of ASCVD. Statins are the cornerstone of the treatment; however, despite the demonstrated benefits of these agents, registries and observational studies have reported statin intolerance prevalence rates of 7% to 29%, with the predominant symptoms being muscle-related side effects.…”

Association of four lipid components with mortality, myocardial infarction, and stroke in statin-naïve young adults: A nationwide cohort study

“…Many studies have demonstrated that improvement of lipid profile leads to reduction in the risk of atherosclerotic CVD (ASCVD) and even mortality. 2–5 Because clinical ASCVD occurs mainly in middle-aged and older adults, previous guidelines have indicated which individuals of this age group could benefit from lipid management. 6,7 However, recent literature states that the cumulative exposure to lipids plays a central causative role in the initiation and progression of atherosclerosis; therefore, experts advise early screening and maintenance of the optimal lipid levels from young adulthood to achieve ideal cardiovascular health.…”