Raising high-density lipoprotein cholesterol and lowering low-density lipoprotein cholesterol as adjunctive therapy to coronary artery revascularization

Several studies shortly after the advent of coronary artery bypass surgery reported early atherosclerosis in saphenous vein grafts, and an association between dyslipidemia and graft occlusion, Lipid-lowering therapy in a numb er of trials resulted in reduced progression of atherosclerosis in vein gra fts and fewer subsequent revascularization procedures. Presently, however, only a few patients are treated and reach target lipid levels. Percutaneous coronary interventions permit rapid relief of symptoms and ischemia, and r eturn to full activity levels, but may not reduce the risk of death or nonf atal myocardial infarction in patients with chronic stable coronary artery disease. Whether optimal medical therapy, including aggressive lipid contro l, could decrease the need for some of these procedures is the subject of o ngoing debate and research. Despite successful coronary artery revasculariz ation, subsequent ischemic events continue to occur, supporting the require ment for successful secondary prevention interventions. Ultimately, optimal care of revascularization patients should include maximizing lipid profile s, (C) 2000 by Excerpta Medica, Inc.