Is aggressive cholesterol control justified? Review of the post-coronary artery bypass graft trial

The Post-Coronary Artery Bypass Graft (CABG) trial was undertaken to compar e the efficacy of aggressive low-density-lipoprotein (LDL) cholesterol lowe ring (<85 mg/dL) with moderate LDL-cholesterol lowering (130-140 mg/dL) in preventing atherosclerotic progression in saphenous vein grafts. In bath th e aggressive- and moderate-treatment groups, clinicians,titrated lovastatin dosages based on individual patients' LDL-cholesterol levels. Based on ang iography performed 4-5 years after enrollment, the rate of disease progress ion was 31% lower in aggressive-treatment patients than in those who receiv ed moderate treatment. Compliance with lovastatin therapy was 85-90%, The r esults confirm that LDL-cholesterol levels should be decreased to <100 mg/d L in patients with coronary artery disease. The challenge is ta ensure that at-risk patients receive drug therapy in adequate, individualized doses. ( C) 1998 by Excerpta Medica, Inc.