Aggressive cholesterol lowering delays saphenous vein graft atherosclerosis in women, the elderly, and patients with associated risk factors - NHLBI post coronary artery bypass graft clinical trial

Background-The NHLBI Post Coronary Artery Bypass Graft trial (Post CABG) sh owed that aggressive compared with moderate lowering of low-density lipopro tein-cholesterol (LDL-C) decreased obstructive changes in saphenous vein gr afts (SVGs) by 31%.(1) Using lovastatin and cholestyramine when necessary, the annually determined mean LDL-C level ranged from 93 to 97 mg/dL in aggr essively treated patients and from 132 to 136 mg/dL in the others (P<0.001) . Methods and Results-The present study evaluated the treatment effect in sub groups defined by age, gender, and selected coronary heart disease (CHD) ri sk factors, ie, smoking, hypertension, diabetes mellitus, high-density lipo protein cholesterol (HDL-C) <35 mg/dL, and triglyceride serum levels greate r than or equal to 200 mg/dL at baseline. As evidenced by similar odds rati o estimates of progression (lumen diameter decrease greater than or equal t o 0.6 mm) and lack of interactions with treatment, a similar beneficial eff ect of aggressive lowering was observed in elderly and young patients, in w omen and men, in patients with and without smoking, hypertension, or diabet es mellitus, and those with and without borderline high-risk triglyceride s erum levels. The change in minimum lumen diameter was in the same direction for all subgroup categories, without significant interactions with treatme nt. Conclusions-Aggressive LDL-C lowering delays progression of atherosclerosis in SVGs irrespective of gender, age, and certain risk factors for CHD.