Effects of aggressive cholesterol lowering and low-dose anticoagulation onclinical and angiographic outcomes in patients with diabetes - The post coronary artery bypass graft trial

Diabetic patients have greater risk for coronary heart disease (CND) events after coronary artery bypass graft (CABG) surgery than nondiabetic patient s. The Post CABG trial studied the effects of aggressive cholesterol loweri ng and low-dose anticoagulation in diabetic patients compared with nondiabe tic patients. A double-blind, randomized clinical trial in 1,351 patients ( 1-11 years after CABG), the Post CABG trial consisted of two interventions (aggressive cholesterol-lowering versus moderate lowering and low-dose warf arin versus placebo) on angiographic end points. Angiographic changes in sa phenous vein graft conduits 4.3 years after entry were compared in 116 diab etic and 1,235 nondiabetic patients. Seven clinical centers participated in the trial, as well as the National Institutes of Health project office (Na tional Heart, Lung, and Blood Institute), the coordinating center (Maryland Medical Research Institute), and the Angiogram Reading Center (University of Minnesota). Baseline characteristics of the diabetic patients differed f rom the nondiabetic patients in the following ways: percentage of women par ticipants, 15 vs. 7%, P = 0.002; mean baseline weight, 87.4 vs. 82.8 kg, P = 0.006; mean BMI, 29.5 vs. 27.6 kg/m(2), P = 0.0002; mean systolic blood p ressure, 141.7 vs. 133.6, P < 0.0001; mean triglyceride concentrations, 2.0 9 vs. 1.77 mmol/l, P < 0.0001; and mean HDL cholesterol concentrations, 0.9 3 vs. 1.02 mmol, P = 0.0001. The percentage of clinical events was higher i n diabetic than nondiabetic patients (20.6 vs. 13.4, P = 0.033) and angiogr aphic outcomes were not different. The benefits of aggressive cholesterol l owering were comparable in diabetic and nondiabetic patients for the angiog raphic end points. Warfarin use was not associated with clinical or angiogr aphic benefit. Diabetic patients in the Post CABG trial had more CHD risk f actors at study entry and higher clinical event rates during the study than nondiabetic patients. The benefits of aggressive cholesterol lowering in d iabetic patients were comparable to those in nondiabetic patients for both angiographic and clinical end points. The small number of diabetic patients provided limited power to detect significant differences between diabetic and nondiabetic patients or between diabetic patients in the aggressive ver sus moderate cholesterol treatment strategies.