RISK FACTOR CONTROL 5 YEARS AFTER CORONARY-BYPASS GRAFTING

The prevalence of three major coronary risk factors, hyperlipidaemia, hypertension acid cigarette smoking, and the change in lipid fractions were assessed five years after coronary bypass surgery and compared t o pre-operation in 353 consecutive patients undergoing elective first time surgery at a single centre. Five years after surgery 309 patients were alive without further cardiac surgery,questionnaire follow-up wa s available in 291 (94%). Lipid profile measurements were made in 255 (83%) of these five-year survivors and 100 (34%) had a history of hype rtension. Five years after surgery, 146 (50%) of the 291 patients thou ght they had high cholesterol, of whom 92 (63%) were following a diet, 36 (25%) were also taking lipid-lowering drugs and 18 (12%) were taki ng no measures; 141 (48%) of them did not think they had high choleste rol, and four (2%) did not know. There had been a favourable change in all lipid fractions compared with pre-operation, including total seru m cholesterol, particularly in patients taking lipid-lowering drugs. H owever, total serum cholesterol was above 5.2 mmol/l in 203 (80%) pati ents and low-density lipo-protein (LDL) cholesterol was above 3.4 mmol /l in 180 (71%). Only 30% of patients taking lipid-lowering drugs had an LDL cholesterol of 3.4 mmol/l or less. Blood pressure was recorded in 257 (83%) of the 309 five-year survivors: 82 (28%) were taking anti hypertensive medication; 32 (12%) and 87 (34%) patients had a diastoli c blood pressure above 95 mmHg and 90 mmHg, respectively, and 49 (19%) had a systolic blood pressure above 160 mmHg. There were 22 (9%) regu lar cigarette smokers. Corroboration of non-smoking with exhaled carbo n monoxide measurements confirmed an accurate history of non-smoking i n nearly all patients.