Lipid lowering and coronary bypass graft surgery

This article reviews the rationale for lipid lowering in patients who have coronary heart disease, and specifically for postbypass patients, It has be en well demonstrated that after coronary artery bypass graft surgery, ather osclerosis continues to progress in the native circulation and develops at an accelerated rate in saphenous vein bypass grafts. During the last decade , numerous clinical trials based on angiographic or clinical outcomes have clearly shown the beneficial effect of lipid lowering in coronary heart dis ease. Three trials (CLAS, post-CABG, and CARE) have demonstrated delayed pr ogression of atherosclerosis in SVGs and/or a reduction of cardiac deaths, nonfatal MI, and the need for revascularization after lowering LDL-choleste rol, The recommended target of LDL cholesterol level of more than 100 mg/dl can be safely reached with diet and monotherapy using one of the statin dr ugs (HMG-CoA reductase inhibitors). Despite this widely-circulated informat ion, there appears to be inadequate public and professional awareness of th e importance of properly managing hyperlipidemia after coronary artery bypa ss graft surgery. (C) 2000 Lippincott Williams & Wilkins, Inc.